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Lege Artis Medicinae - 1994;4(03)
Content
Lege Artis Medicinae
MARCH 30, 1994
[Hormone replacement therapy from a gynaeco oncological point of view]
[In Hungary, hormone replacement therapy (HRT) has been used more extensively in the last few years. The benefits of HRT in cardio vascular diseases, osteoporosis and quality of life have been well established. Breast cancer and endometrial carcinoma have been considered as contraindications for HRT. A reappraisal of this practice is necessary since we have no evidence that HRT may adversely influence the outcome of these tumours, al though this is theoretically possible since the effect of estrogens on occult metastases is unknown. The relationship between replacement therapy and the uterine sarcomas is of particular concern. HRT is safe in patients successfully treated for carcinoma of the vulva, vagina, uterine cervix and in those with ovarian cancer. Experience suggests that estrogen can also be used safely in women treated previously for endometrial cancer. As far as breast cancer is concerned, it appers logical to discuss the risk-benefit considerations with our patients before embarking on using HRT. Consultation with a gynaecological oncologist prior to HRT in patients with endometrial and/or breast cancer is strongly recommended. ]
Lege Artis Medicinae
MARCH 30, 1994
[Developing a complex approach to hospice and home-care]
[The home-care and hospice movement has been sporadically encountered in the hospital and care network for a long time, and we have already seen all that this paper aims to do. Across the country, hospitals and specialist outpatient departments alike are seeking ways and means of providing this care. ]
Lege Artis Medicinae
MARCH 30, 1994
[Letters - Spontaneous pneumothorax]
[Dear Editorial Team! In the 30 November 1993 issue, AC Miller and JE Harvey's "Guidelines for the management of spontaneous pneumothorax" was published as a position paper of the British Thoracic Society. It may seem an ungrateful undertaking to enter into a debate with the principles of such a venerable and long-established society.]
Lege Artis Medicinae
MARCH 30, 1994
[The increasing threat of antibiotic resistance: implications for antibiotic prescribing in community practice]
[Infectious diseases caused by bacteria have been treated successfully by antibiotic the rapy for the past half century, and a diversity of antibacterial agents with widely differing mechanisms of action has been developed by the pharmaceutical industry. However the selective pressure of antibiotic usage has inevitably led to the isolation of resistant bacteria and the rate of emergence of antibiotic resistance appears to be increasing rapidly, reducing the effectiveness of existing agents. Factors responsible for the wide dissemination of antibioticresistant bacteria in both community and hospital practice include the acquisition and spread of resistant genes by plasmids and transposons, inappropriate anti biotic usage and social factors. Mechanisms to controll the emergence of antibiotic resistance require optimal usage of antibiotics by clinicians, control programmes to improve hygiene and to reduce the transmission of resistant bacteria within and between communities, and the continued development of new antibacterial agents.]
Lege Artis Medicinae
MARCH 30, 1994
[Highly located and intrahepatic malignant biliary stenoses treated by interventional radiological procedures]
[In the palliative treatment for patients with highly located and/or intrahepatic malignant biliary stenoses or obstructions interventional radiological procedures may play a significant part. In 12 patients with obstructive jaundice caused by highly located malignant stenosi(es) or obstruction(s) 23 endoprostheses were implanted. In 5 cases double endoprosthesis placement was performed to connect isolated lobes or segments of the liver. Patients' survival was 4–22 (average 8, 7) months. In 6/12 patients surviving for 4-8 months, occlusion of the endoprostheses did not occur. In the other half of the patients, in whom the disease permitted a longer life-expectancy, prosthesis occlusion led to recurrent jaundice within 3–11 months. In all but one case, in which endoscopic exchange was successful, percutaneous interventions were necessary. Successful endoprosthesis placement was carried out 3 times in one patient and once each another 5 patients following percu taneous extraction (3 times), distal displacement (twice) and endoscopic removal (twice) of the occluded endoprostheses. Authors consider percutaneous endoprosthesis placement an effective procedure in the palliative treatment of the aforementioned patients' group, both for improving their survival and quality of life. They emphasize the fact that lengthy and difficult manipulations are required for these procedures which consequently result in a considerable amount of scattered radiation exposure to those performing the procedures.]
Lege Artis Medicinae
MARCH 30, 1994
[Relationship between ventricular arrhythmias left ventricular dysfunction and late potential after myocardial infarction and during follow up]
[The prognostic significance of post myocardial infarction dysrhythmias and left ventricular dysfunction is well established. We studied the role of late potentials to predict these two abnormalities. A prospective study of the relationship between signal averaged electrocardiogram, left ventricular function and 24 hour Holter ECG monitoring was performed in 39 patients 16,3 + 17,7 days and 16,3 +8,9 months after myocardial infarction. The late potentials were determined by the following parameters: duration of the high-frequency and low amplitude signals (HFLA), voltage in the terminal 40 ms (RMS) and duration of filtered QRS waves (QRS). The left ventricular function was measured by 2D-echocardiography and the rhythm disturbances were detected by Holter ECG monitoring or by our self-developed on-line arrhythmia monitoring. No difference was noted in age (63 versus 58 years, NS), and in the three late potential parameters (HFLA: 34 versus 34 ms, NS; RMS: 43 versus 38 uv, NS; QRS: 109 versus 114 ms, NS) between the groups of patients with normal( 1 group: EF > 40%) and abnormal (2nd group: EF < 40%) left ventricular function. There was a significant difference in all three late potential parameters between the two groups of patients (A. and B. groups) based on the appearance of ventricular rhythm abnormalities (HFLA: 43 versus 31 ms, p<0,01; RMS: 24 versus 47 uv,p<0,05; QRS: 121 versus 106 ms, p<0,01). High resolution electrocardiography may be of prognostic value in selecting a high risk subset of patients (ventricular arrhythmias, sudden death) after myocardial infarction. ]
Lege Artis Medicinae
MARCH 30, 1994
[Successful treatment of a complex supraventricular arrhythmia from the 26th gestational week]
[Intrauterin fetal arrhyth mias may cause severe problems, sometimes intrauterine or neonatal death. An atrial flutter with orthodromic reciprocating tachycardia was detected (ATL, Ultramark 9 type echocar diograph, M-mode, 2 dimension and color Doppler imaging) in a fetus at the 26th week of gestation. Antiarrhythmic transplacental drug therapy was introduced first with digoxin (0,25 mg/die) and later a digoxin-verapamil (0,5 mg/die, 80 mg/die respectively) combination thereafter. Maternal blood digoxin concentrations were 1.4 ng/ml; 1.1 ng/ml and, at last 1.76 ng/ml. The digoxin-verapamil combination converted the tachycardia in utero. The authors suggest that first choice of therapy in such cases should be digoxin at a 2.0 ng/ml maternal serum level. The treatment should be started in hospital with a daily ultrasonography follow-up. After conversion weekly controls are enough. Diagnosing the arrhythmia the 35. week of gestation termination of the pregnancy and the treatment of the newborn are suggested. ]
Lege Artis Medicinae
MARCH 30, 1994
[Danish verapamil infarction trial I]
[To assess whether starting treatment with IV verapamil at the time of suspected infarction and continuing it for 6 months reduces the rate of death or re-infarction in the following 6 months.]
Lege Artis Medicinae
MARCH 30, 1994
[Home-care for terminally ill cancer patients initial experience]
[The authors report on their initial experience with home-care of terminally ill cancer patients. Fifteen patients were followed between 1 October 1992 and 1 October 1993 using a special recording form. The data of eight patients were compared. The home-care team consisted of oncologists, nurses, social workers, priests and volunteers. A pain specialist was available for consultation. The authors emphasize the importance of symptom control and psychosocial assistance. They present the benefits of home-care, which is a special support system for terminally ill cancer patients and their families. General practitioners and disburdens the hospitals. In our knowledge this is the first report on a home-care team in Hungary.]
Lege Artis Medicinae
MARCH 30, 1994
[High dose short term thrombolytic therapy in pulmonary embolism]
[A new thrombolytic method for rapid and safe therapy of pulmonary embolism is presented. Three cases of successful thrombolytic treatment of pulmonary embolism are discussed. In each case high dose, short term streptokinase therapy was used (3 million U/2"), followed by rapid anatomical, haemodynamical and clinical improvement without bleeding side effects. The authors recommend this type of therapy for pulmonary embolism. ]
Lege Artis Medicinae
MARCH 30, 1994
[Declaration of San Raffaele]
[The European Parliament (EP) Health Department of the European Parliament and the Quality Assurance Unit of the World Health Organization (WHO), was held in Milan, at the San Raffaele Hospital, from 27 to 30 September 1993. Experts in the field of quality assurance and those interested in the subject, mainly from Central and Eastern European countries, discussed the possibilities and prerequisites for the provision of high quality and cost-effective health care.]
Lege Artis Medicinae
MARCH 30, 1994
[Monitoring the reporting of performance measurement in outpatient care initial experience]
[The authors examined the performance measurement and reporting system according to the WHO scoring system in outpatient care during the first month of implementation. The formal and substantive errors associated with the implementation were classified into four groups. In the context of this paper, the errors identified are highlighted to draw the attention of health care providers and their associated professional and funding bodies to the need to comply with the performance measurement and reporting rules, which has a significant impact on the financial balance sheets of both the provider and the funder. ]
Lege Artis Medicinae
MARCH 30, 1994
[Dilemma]
[After the hard and the soft dictatorship, it is understandable that the indoctrination of the past is still alive in the gut; mixed with the mechanisms of a fledgling democracy, it creates its own conflicts, where both the decision and the truth are difficult to pronounce]
Lege Artis Medicinae
MARCH 30, 1994
[Swamp or tunnel]
[While it is a fact that the 1994 appropriation includes a 27 percent increase over the 1993 projected expenditure, the health profession considers that health care has reached the point of no longer being able to sustain a real decline in viability without serious threats to medical activity." ]
Lege Artis Medicinae
MARCH 30, 1994
[Party fights - party faces]
[Who would have thought, even a year ago, that months before the elections, a forum with the above title, attended by leading health politicians from the parliamentary parties and a spokesperson for the Republic Party, which is also a prestigious medical doctor, would end in disinterest. However, not only this event, but also the presentations on the situation and prospects of health insurance and health businesses, and the main event, the exhibition of medical instruments interest. ]
Lege Artis Medicinae
MARCH 30, 1994
[Funding and professional protocols]
[This time, the LAM Club discussed funding and professional protocols. The debate was hosted by András Szepesi, representative of the Health Insurance Self-Government. The forum was moderated by István Bordás, Director of Gyógyinfok, András Forgács from the MOK, Géza Pataki from the Pulmonology Professional College and Béla Ralovits from the Ministry of Public Welfare. ]
Lege Artis Medicinae
MARCH 30, 1994
[Relief of the plague epidemic]
[The horrors of the plague in Vienna in 1679 are captured in the terracotta relief on the cover A. The small sculptural sketch in the Budapest Museum of Fine Arts was created by one of the most important Austrian architects and sculptors, Johann Bernhard Fischer von Erlach (1656 Graz - 1723 Vienna) around 1688 for the Holy Trinity Column on the Vienna Graben, but his bozzetto is also used on the Pesti column in Prechtoldsdorf (Lower Austria).]
Lege Artis Medicinae
MARCH 30, 1994
[History of medicine]
[Book description History of Medicine from Antiquity to 2020 - Nancy Duin, dr Jenny Sutcliff]
Lege Artis Medicinae
MARCH 30, 1994
[History of the Health Science Council (1868-1990) Part II]
[The reorganisation of the Scientific Council for Health was reintroduced in 1976 due to its overcrowding and unwieldiness. Its operation was regulated by the Minister of Health, Dr. Emil Schultheisz, in his Instruction No. 31/1976 EüK. 23/EC/M. The Council operated on this basis until 1 June 1989. The Instruction contained, inter alia, the following provisions: ]
Lege Artis Medicinae
MARCH 30, 1994
[Natural law and positivist elements in the rules of medical practice Part I]
[Is it possible, and if so how, to influence medical practice through the law, especially in the light of recent developments in medical science? This is a question that concerns and concerns many. Arnold Toynbee and Daisaku Ikeda's dialogue on medical ethics two decades ago, in which Ikeda expressed many of his doubts, has not lost its relevance today.]
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