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Lege Artis Medicinae - 1994;4(05)
Content
Lege Artis Medicinae
MAY 25, 1994
[Tuberculosis an immunological perspective]
[Tuberculosis is one of the most frequent infections in the world, with at least one third of the world's population carrying the pathogen. The number of active tuberculosis cases is increasing in the industrialized nations. The human immune system is unable to clear M. tuberculosis completely. The immune response in tuberculosis may be summarized as follows: M. tuberculosis is an intracellular pathogen living in the macrophages and evading the cell's effective antibacterial mechanisms. The defense against tuberculosis is a local event, resulting in a labile balance between host and parasite. Bacteria can survive in the tuberculotic granuloma and are prepared at any time to spread the organism in case of defective cell-mediated immunity. Activated macrophages play a pivotal role in the defence against Mycobacteria. The appropriate activation and cooperation of T cells is mandatory to mount a protective immune response. BCG vaccination is inefficient in protecting against adult tuberculosis but does protect newborns from disseminated tuberculosis. New vaccines or vaccination procedures are needed to develop a protective immunity against tuberculosis. ]
Lege Artis Medicinae
MAY 25, 1994
[Immunotherapy for tuberculosis clinical aspects of immunological research]
[Efforts toward developing an immunotherapy for tuberculosis are based upon the knowledge of delayed hypersensitivity and cellular immunity. The aim of immunotherapy is to strengthen the cellular immunity, enabling the immune system to destroy those persistent bacteria which remain alive following chemotherapy. Chemotherapy combined with an appropriate dose (10%) of dead M. vaccae significantly improved the therapeutic results of tuberculosis patients and reduced their mortality in double blind controlled studies. A beneficial effect was also observed in the treatment of chronic, multidrug resistent cases and in HIV positive tuberculosis patients. The duration of chemotherapy can be considerably shortened when concurrent immuno therapy is utilized.]
Lege Artis Medicinae
MAY 25, 1994
[Color and pulsed doppler velocimetry of the uterine artery in the second part of the normal pregnancy]
[Color Doppler imaging allows accurate identification of the main uterine arteries, which reflect the sum of the resistance of the placental bed and are therefore more likely to provide an overall picture of placental perfusion. In a cross-sectional study of 231 healthy women with singleton pregnancies at 19–40 week's gestation, color Doppler imaging was used to identify the main uterine arteries for subsequent pulsed Doppler studies. Flow velocity waveforms were obtained and indices of impedance, peak systolic blood velocity and mean blood velocity were measured. Impedance to flow decreased, whereas blood velocity increased significantly with gestation. Furthermore, impedance to flow was lower and velocity higher in the placental uterine artery (closest to the main bulk of the placenta) than in the non-placental artery. The changes in the uterine blood flow during normal pregnancy provide indirect evidence for the increase of the maternal blood supply necessary for normal intrauterine development. Definition of the reference ranges of parameters used to characterize blood flow velocity wave forms has an importance in the investigation of complicated pregnancies. ]
Lege Artis Medicinae
MAY 25, 1994
[Correspondence]
[On outpatient care from the perspective of the hospital outpatient clinic; The doctor's medicine; Renew or reassess; ]
Lege Artis Medicinae
MAY 25, 1994
[Epidemological findings of inflammatory bowel diseases in borsod county 1963-1992]
[The epidemiologic data of inflammatory bowel diseases and the clinical aspects of ulcerative colitis and Crohn's disease were evaluated among the 800 000 inhabitants of Borsod County during three decades. Inflammatory bowel disease cases were continuously gathered from all the hospitals in the county. Patients were examined by standard diagnostic criteria. Consultative endoscopic advice, follow-up, and drugs prescription were provided on the wards. Patients' data were systematically registered and summarized. The following data were recorded: the patients' age, sex, ethnic group, urbanization; family prevalence, anatomical extension, type of course, severity of disease, and the occurance of malignant transformation. The authors registered 913 patients with inflammatory bowel disease, in the 10 hospitals of Borsod County between 1963 and 1992. 488 cases of ulcerative colitis were detected during the first twenty years, which is an incidence rate of 3.1/ 100,000 per year. The incidence during the third decade was 3.6/100,000 per year. 69 patients with Crohn's disease were examined during the first 20 years, and 78 in the third decade. The incidence of ileocolonal Crohn's disease increased from 0.43 to 1.00/100,000 per year. The authors didn't find a significant change in anatomical extension, severity or the clinical course of ulcerative colitis during the three decades. The increase of Crohn's diseases, and especially of isolated colonic types, may reflect improved diagnostic techniques. The incidence of inflammatory bowel disease increased among gypsies, but the incidence in that population was still only half of what was expected in the region. The authors found familial inflammatory bowel disease occurrence in 15 patients. Eight carcinomas were observed in the 766 ulcerative colitis patients, and 2 in the 147 Crohn's disease patients. ]
Lege Artis Medicinae
MAY 25, 1994
[Experience with endobronchially localised benign tumors]
[The authors studied histologically verified, benign endobronchial tumours. Twenty seven tumours were discovered in our department in a 3 year period and 3 of them were surgically removed. From the group of 24 tumours unresectable for tehcnical or clinical reasons, 21 were endoscopically removed. During the follow-up tumour recurrence has not been observed. Most of the clinical symptoms improved significantly following tumour resection. These findings suggest that in well-defined cases, benign endobronchial tumours should be resected bronchologically. ]
Lege Artis Medicinae
MAY 25, 1994
[Danish verapamil infarction trial II]
[To study whether treatment with verapamil, starting in the second week of infarction and continuing for 12-18 months, reduces all-cause mortality and the incidence of major coronary events (death, reinfarction).]
Lege Artis Medicinae
MAY 25, 1994
[Complex resuscitation of adult patients]
[The European Resuscitation Council was established in 1990 with the aim of saving lives by raising the standard of cardiopulmonary resuscitation in Europe and coordinating the activities of interested organisations and individuals. In this respect, it has not only succeeded in bringing together internists and surgeons from Eastern and Western Europe, but has also established links with the American Heart Association and with organisations with similar activities in Canada, Australia and South Africa.]
Lege Artis Medicinae
MAY 25, 1994
[Basic guidelines for resuscitation]
[The European Resuscitation Council's First Aid Task Force was set up in 1991. One of its aims was to develop generally accepted basic guidelines for resuscitation to enable uniform training of both health professionals and lay people throughout Europe. In the past, there had been frequent complaints, particularly from lay people attending CPR courses, that different organisations were teaching different methods. This problem exists within countries and internationally. The European Resuscitation Council publishes below its basic resuscitation guidelines in the hope that they are detailed enough to avoid misunderstandings and that they will be adopted and applied in all member countries. ]
Lege Artis Medicinae
MAY 25, 1994
[The videoendoscopic implantation of the breast prosthesis]
[The authors realized in the course of CT and MRI investigations that breast prosthesis implantation is generally performed with a very invasive technique. A reliable surgical technique is recommended, wich excludes the possibility of the usual complications, assures a successful implantation, and reduces the invasiveness of the surgery. During a one year period, 21 augmentations were performed for cosmetic reasons, 3 cases of capsular contracture were resolved, and 2 procedures utilizing a prosthesis inserted under a musculocutaneous flap of the latissimus dorsi muscle were completed with a minimally invasive technique. The essential feature of this method is that a cold light emitting spatula is utilized in the exploration and in the videoendoscopic surveying of the prepared region. The smallest incision measured 30 mm, the largest reached 47 mm. No scar tissue formation was observed. This operative technique significantly reduces the scar formation and the invasiveness of the procedure and therefore may be expected to replace the traditional implantation method. ]
Lege Artis Medicinae
MAY 25, 1994
[The big target: eradication of poliomyelitis by 2000]
[The decisive turning point in the fight against poliomyelitis (epidemic polio) was the solution to the problem of how polioviruses can be cultured on tissue culture in 1948, followed by the discovery of an inactivated poliovirus vaccine for mass vaccination in 1953 (Salk vaccine). Subsequently, the discovery and widespread use of live vaccines was a major step forward (Sabin vaccine: licensed in the USA in 1961, but used for mass vaccination in many countries as early as 1960). The WHO Expanded Programme on Immunisation, which began in 1974, included poliomyelitis as a target disease. Surveys published in 1977 made it clear that poliomyelitis was a major public health problem in developing countries. The fight against poliomyelitis was also given new impetus by the eradication of smallpox, which was completed in 1977 and formally declared in 1980. The major goal of eradicating poliomyelitis by the year 2000 was adopted by the WHO General Assembly in 1988. The key to eradication is the presence of live poliovirus vaccine (Sabin vaccine), which is a vaccine that can confer local immunity and thus break the chain of infection, thus eliminating the wild virus from the population. Hungary is playing its part in the international fight to eradicate poliomyelitis, including through its high and exemplary poliomyelitis vaccination coverage rate. ]
Lege Artis Medicinae
MAY 25, 1994
[Outpatient care laboratory reform '93]
[The data from the first four months of the reform of the outpatient care system (based on data from the OEP's Health Financing Department) have highlighted several phenomena that it would be useful to report. For the time being, this report only deals with data on laboratory care within the outpatient specialised care sector, on the assumption that those who practise "metric medicine" provide more accurate and more processable information.]
Lege Artis Medicinae
MAY 25, 1994
[Where to go from GP institute]
[The Institute of General Practice was established in December 1991 in the three ground floor offices of the former Central State Hospital (Kútvölgyi). The Ministerial Decree of the Ministry of Public Welfare establishing it was intended as a scientific, research, methodological and training back-up institution of the Ministry. According to its charter, its tasks - within the framework of specialised general medical care - are to evaluate the morbidity of the population, to develop a system of data collection, to evaluate examination methods, to issue and monitor the implementation of methodological letters, to monitor and comment on the operating conditions of institutions and services in the field of primary care, to propose justified amendments to legislation, to provide methodological and methodological guidance for health research and, within the framework of the legislation on education, to define the principles and methods of vocational training and further training. ]
Lege Artis Medicinae
MAY 25, 1994
[About my discussions with the editor-in-chief]
[Probably my problem in this case is that I like three things almost equally: the paper, the editor-in-chief and the debate, and sometimes it's hard to reconcile them. ]
Lege Artis Medicinae
MAY 25, 1994
[News]
[Disposable contact lenses; Medical writing congress in France; Preventive and molecular oncology]
Lege Artis Medicinae
MAY 25, 1994
[Medical faculties at the turn of the century]
[After the Reunification, József Eötvös' second term as Minister brought fundamental changes in higher education, including medical education. In the run-up to the university reforms, several measures were taken to improve the conditions for medical education, such as the establishment of the Institute of Chemistry, the introduction of practical midwifery as a compulsory subject and the opening of examinations to the public. Perhaps the most important of these measures was the generalisation of the diploma of the Faculty of Medicine in Pest, which was extended to the whole territory of the dualist state. ]
Lege Artis Medicinae
MAY 25, 1994
[Dutch euthanasia law]
[In the Netherlands, euthanasia (euthanasia = active euthanasia) will be allowed in the future, within certain limits. With this decision, the Dutch governing coalition is seeking to put an end to an issue that has been controversial for almost 20 years. MEPs have imposed strict conditions on the use of euthanasia. Before the law enters into force, it is still before the Senate for debate. ]
Lege Artis Medicinae
MAY 25, 1994
[Characteristics of practices in Dutch and Hungarian college nursing education]
[An essential feature of the modernisation of the domestic healthcare system has been the need for a modern tertiary (college) nursing education network. Newly trained professionals will have a role to play in health promotion, hospital and primary care, as well as in aftercare, while at the same time gaining moral and financial recognition. This may seem a bold objective under current conditions, but it could become increasingly realistic in the next decade.]
Lege Artis Medicinae
MAY 25, 1994
[The healer-doer sunglasses]
[A long time ago, when gods still lived in the land of Egypt under the rule of the sun god Ra, his lovely daughter, the light of the sun's eye called Tefnut, moved to the land of Bugem in northern Nubia, where she lived her life in the form of a wild cat. But his father longed for him and entrusted Thoth, the god of wisdom, with the task of bringing him back to him.]
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