Lege Artis Medicinae - 1994;4(04)

Lege Artis Medicinae

APRIL 27, 1994

[Laboratory control of the oral anticoagulant therapy]

VAJDA Zoltán, PÁL András, SIKOS Zita, SAS Géza

[There are two basic requirements in the treatment and prophylaxis of thromboembo lic diseases by chronic anticoagulation with coumarin (Syncumar). The first is the preven tion of a new thrombosis while the second is the avoidance of concomitant bleeding complications. For this reason it is necessary to achieve an appropriate anticoagulation level which can be characterised by labora tory measurement of the prothrombin level. In this paper, the theoretical and practical as pects of the laboratory control of Syncumar treatment are reviewed. The most serious problem is that the prothrombin level (Quick time) determinations utilising thromboplastin preparations from different sources give diffe rent values in the same patient plasma, which makes comparison of data from different laboratories impossible. The paper gives a brief overview of the definition and practical use of the International Sensitivity Index (ISI), characterising the different thromboplastin preparations, and the International Normali sed Ratio (INR) which can be calculated on the basis of the ISI. In spite of unquestionable improvements, the uncertainty about instrument-thromboplastin-ISI relationships reduces confidence in the INR system, especially when differences in INR values have clinical significance. Efforts need to be directed toward providing local, laboratory/instrument specific ISI values. ]

HUN 1994;4(04)

Lege Artis Medicinae

APRIL 27, 1994

[The clinical significance of amaurosis fugax]

HORVÁTH Sándor, SOMLAI Judit

[The symptoms of amaurosis fugax (transient monocular loss of vision) indicate not only atherosclerotic disease of the ocular or extra cranial cerebral vessels, but also that of the systemic circulation. The prognostic significance of amaurosis fugax developing after the age of 50-55 years is similar to that of transient ischaemic attack of the brain: it could be a harbinger of atherosclerotic disease of the extra- and intracranial brain vessels as well as the coronary arteries. According to the mortality data, patients presenting with symptoms suggestive of amaurosis fugax will die due to heart disease, primarily myocardial infarct. Diagnostic evaluation should include not only ophthalmological, but also neurological and cardiovascular in vestigation to verify carotid and coronary atherosclerosis. Therapy of the whole disease and not just the symptoms will influence life expectancy in patients with amaurosis fugax. ]

HUN 1994;4(04)

Lege Artis Medicinae

APRIL 27, 1994

[Methylprednisolone pulse therapy in systemic lupus erythematosus]

GERGELY Péter

[The aim of this retrospective study was to assess the efficacy and safety of methylprednisolone pulse therapy. Thirty five patients with severe systemic lupus erythematosus (lupus nephritis, severe hemolysis and antiphospholipid syndrome with central nervous system involvement, arterial occlusion and thombocytopenia) were treated by pulse methylprednisolone, followed by long-term corticosteroid (and cyclophosphamide) therapy. Thirty four patients achieved remission, after a mean of 4.7 weeks, which lasted on average for > 2.7 years. Six patients presented with an exacerbation after 1-2.5 years. Twenty eight patients are still in remission. No side effects were observed during pulse therapy. Methylprednisolone bolus therapy is safe and effective in severe systemic lupus erythematosus, including cases of lupus nephritis and severe central nervous system manifestations, but an appropriate choice of long-term therapy is essential.]

HUN 1994;4(04)

Lege Artis Medicinae

APRIL 27, 1994

[The value of immunoscintigraphy in patients with metastatic malignant melanoma]

PAPÓS Miklós, LÁNG Jenő, CSERNAY László, SZEKERES Lenke, KUBA Attila

[Immunoscintigraphy with 99MTc-labeled F(ab'),fragments of monoclonal antibody (reactive with a high molecular associated antigen) was performed in patients with malignant melanoma. 24 investigations on 23 patients were carried out. A total of 40 lesions in 23 patients were detected by chest radiography, ultrasound, CT, bone scintigraphy or histology. 24 of the 40 lesions (60%) were visualized by immunoscintigraphy. Following correction of the physiological liver background by digital subtraction, 3 liver metastases were localized. These results indicate that immunoscintigraphy with radiolabeled F(ab')2 fragments can provide clinically useful information. ]

HUN 1994;4(04)

Lege Artis Medicinae

APRIL 27, 1994

[Methodological letter from the Public Health and Epidemiology Technical College on vegetarian and similar diets in crèches and educational establishments]

[The nutritional status of vegetarians is strongly influenced by the type of diet they eat. While semi-vegetarian and lacto-ovo-vegetarian diets can meet the nutrient needs of young children, provided they are carefully and professionally planned, strict vegetarian or macrobiotic diets may not meet the needs for some nutrients and may be deficient in both children and adults. ]

HUN 1994;4(04)

Lege Artis Medicinae

APRIL 27, 1994

[Swedisch aspirin low-dose trial]

MATOS Lajos

[To investigate the protective effect of low-dose aspirin after transient cerebral ischaemic attack or minor stroke in preventing stroke or death.]

HUN 1994;4(04)

Lege Artis Medicinae

APRIL 27, 1994

[Non-immune hydrops caused by double-chambered right ventricle of the heart]

HAJDÚ Júlia, SZILLER István, MACHAY Tamás, SZABÓ István, PAPP Zoltán, MARTON Tamás, SZATMÁRI András

[The isolated double chambered right ventricle is a rare congenital cardiac malformation. No such case diagnosed in utero has been published. Our case was associated with hydrops syndrome. This malformation has not been published as a cause of non-immune hydrops. At the 29th week of gestation, a severe form of isolated double-chambered right ventricle was found in a fetus. The diagnosis was based on echocardiographic examination (ATL, Ult ramark 9, M-mode, 2 dimension Doppler, color-coded Doppler). The malformation caused severe hydrops. The authors had differential diagnostic problems because of the rarity of this case. The most common causes of non-immun hydrops fetalis (40% of the cases) are cardiac abnormalities. Modern, high resolution ultrasonic equipment has provided the possibility of detecting these malformations. The fetal prognosis in such cases is poor. ]

HUN 1994;4(04)

Lege Artis Medicinae

APRIL 27, 1994

[Initial experiences with color doppler ultrasonography of rectal tumors]

JAKAB Zsuzsa, LESTÁR Béla, RITTER László, DULISKOVICH Tibor, ARCHIE A Alexander

[The authors report their one-year experiences with color-Doppler ultrasonography in the examination of rectal tumors. 160 transrectal ultrasound examinations were performed. The results of 30 cases with rectal cancer are reported. All 30 patients had gray-scale, pulsed Doppler and color Doppler endorectal ultrasound examination. The vascular structures of the tumors and the normal rectal wall were studied. Flow characteristics and pulsatility indices for arterial waveforms within the tumor tissue and within the normal wall were compared. Hypervascularisation was seen in all of the 30 tumors. In the tumor vessels an increased diastolic flow component was observed with lower pulsatility indices. The mean Pl was 1.206+0.394 (SD) (P<0.001). In the flow pattern of the normal submucosal arterial plexuses, the diastolic flow was absent or minimal and the mean PL was 3.168+1.151 (SD). Different color and pulsed Doppler signal types exist in rectal tumor tissue and in normal rectal wall. The investigation of rectal tumor vascularity may have a special importance in distinguishing tumor tissue from related perifocal oedema which is prerequisite to the determination of the extent of resection. ]

HUN 1994;4(04)

Lege Artis Medicinae

APRIL 27, 1994

[Deployment in Carthage December 1943]

J G Scadding

[I served in the Royal Army Medical Corps for most of the Second World War. In January 1939, I became Chief Medical Officer at Brompton Hospital, but remained on the staff of the British (now Royal) Postgraduate Medical School (Hammersmith), which I joined when it started in 1935.]

HUN 1994;4(04)

Lege Artis Medicinae

APRIL 27, 1994

[Is quinolones contraindicated in infants and children]

SZALKA András

[It is well known that both the older - oxolinsay (Gramurin), nalidixic acid (Nevigramon) - and the newer types of quinolones - norfloxacin (Nolicin), pefloxacin (Peflacine), ofloxacin (Tarivid), ciprofloxacin (Ciprobay) - are contraindicated in infants and children, pregnant women and breastfeeding mothers. ]

HUN 1994;4(04)

Lege Artis Medicinae

APRIL 27, 1994

[Diabetic retinopathy]

EVA M Kohner

[Of all the long-term complications of diabetes, retinopathy is the one that has attracted the most interest - and the most debate. This is not only because the condition often leads to vision loss in working-age patients, but also because, although the clinical course is well understood, the pathological process that causes the lesion and vision loss is not fully understood. In fact, we do not even know why retinopathy progresses so rapidly in some patients that even close care and early treatment do not prevent vision loss, while in others retinopathy progresses slowly and remains mild for years. However, much progress has been made in this area over the last decade. Although more pieces are still missing from the retinopathy mosaic, we are beginning to understand what is really happening and may soon have an idea of how to prevent the blindness-threatening forms of retinopathy.]

HUN 1994;4(04)

Lege Artis Medicinae

APRIL 27, 1994

[News]

[Proposals of the Mammological Section of the Hungarian Society of Oncologists on breast cancer screening; The Hungarian Society of Endocrinology and Metabolism]

HUN 1994;4(04)

Lege Artis Medicinae

APRIL 27, 1994

[The "performance funding" experience of the first six months]

DEMES Istvánné

[Act LXXXIV of 1992 and Government Decree No 52 of 1993 regulated the new funding arrangements. Financing is generally geared to the achievement of health policy objectives and is implemented along the parameters that determine it. When the new financing system was launched, it could not, of course, assume the fulfilment of these objectives in a complex manner, but only contained all these expectations in its elements and inspiration. ]

HUN 1994;4(04)

Lege Artis Medicinae

APRIL 27, 1994

[Information leaflet on the national inspection of core boxes]

MERSÁNY Géza, NÉMETH Zsuzsa

[The family doctor fills in the master file of each insured Hungarian citizen who registers with him/her at the time of registration. This document provides a brief summary of the health status of all registered insured Hungarian citizens. This enables the GP to plan effective prevention and further medical care.]

HUN 1994;4(04)

Lege Artis Medicinae

APRIL 27, 1994

[The magician's party spell]

PELLEI Ilona

[Ethical dilemmas around the use of IVF]

HUN 1994;4(04)

Lege Artis Medicinae

APRIL 27, 1994

[Once again on euthanasia]

FÁKLYA Csaba

[One of the most prestigious of the burgeoning health think tanks is the Liberal Medical Club, which systematically takes on the most sensitive medical issues, from parasolvency to euthanasia.]

HUN 1994;4(04)

Lege Artis Medicinae

APRIL 27, 1994

[From medical school to health sciences university]

NAGY András László

[Excerpts from the opening speech of Gábor Brooser, Rector of the Council of the Imre Haynal University of Health Sciences, at its public ceremonial meeting.]

HUN 1994;4(04)

Lege Artis Medicinae

APRIL 27, 1994

[Before the pay settlement]

ILKEI Csaba, SURJÁN László

[Time does not allow me to recall the details of the protracted pay dispute, the root cause of which is that health workers have not received the decent basic salary and allowances due under the Public Servants Act since 1 January.]

HUN 1994;4(04)

Lege Artis Medicinae

APRIL 27, 1994

[Natural law and positivist elements in the rules of medical practice Part II]

LŐRINCZ Jenő

[In the Hippocratic collection, in addition to the text of the medical oath, there are also rules and regulations on medical practice. Today, more than fifty works from the 4th to 5th centuries BC are included in this collection, which are diverse in their approach and subject matter, one of the authors being Hippocrates himself.]

HUN 1994;4(04)

Lege Artis Medicinae

APRIL 27, 1994

[Medicine or poison]

NÉMETH István

[Opinions on smoking in the 17th century ]

HUN 1994;4(04)

Lege Artis Medicinae

APRIL 27, 1994

[Changes in the medical oath in response to societal expectations and internal ethical requirements]

GAIZLER Gyula

[The medical oath, like so many other things, faithfully follows the external, social and internal, changes and requirements of the profession. It is only natural that in our times, when the general crisis and rethinking of values is as natural as the air we breathe, the medical oath, as one of the most important of the deontological, legal regulators, has become the focus of increasing attention for many. Its distinctive, evolved form draws on two millennia of tradition, with both conservative and progressive features. Its importance is enhanced by its influence on the inner conscience of the doctor. In our country, the traditional character is usually emphasised, but the more attentive observer will soon notice that the specificities reflect the positions of the time. ]

HUN 1994;4(04)