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Lege Artis Medicinae - 1994;4(07)
Content
Lege Artis Medicinae
JULY 27, 1994
[Ultrasonic signs of suspected fetal chromosomal aberration]
[The authors summarize the relevant ultrasonic findings in case of suspected fetal chromosomal aberration. Some of these signs are detectable during routine ultrasonic screening examinations. In high-risk cases, prenatal chromosomal analysis is recommended. The following ultrasonic findings indicate a situation of high risk: disturbances of the lymphatic and amniotic fluids (e.g. hydrops, hygroma colli, polyhydramnios, nuchal edema), certain skull and brain alternations, abnormalities of the thorax and abdomen, and „minor” findings such as a single umbilical artery, choroid plexus cyst, pyelectasy, or changes in the size or shape of the long tubular bones, if these signs are accompanied by other anomalies or growth retardation.]
Lege Artis Medicinae
JULY 27, 1994
[Advantages and limits of the open tube and flexible esophagoscopes]
[The two types of endoscopes presently available for examination and treatment of the esophagus are the traditional open tube esophagoscope and the flexible endoscope. Despite the many advantages offered by the flexible endoscope, its limitations should not be forgotten. The open tube esophagoscope should not be thought of as out-of-date, since its new variations have important therapeutic applications. The authors examine the advantages and disadvantages of the two types of esophagoscopes as discussed in the literature. ]
Lege Artis Medicinae
JULY 27, 1994
[An update on obstructive sleep apnea]
[Obstructive sleep apnea, which occurs in approximately 2% of the adult population, is the more common of the two major forms of sleep apnea. The conse quences and dangers of excessive daytime sleepiness are emphasized along with the other well-known characteristics of sleep apnea syndrome. Both the decreased upper airway muscle tone during sleep and the negative pressure due to breathing through the obstructed airways may cause upper air ways to collapse. The history has a very important role in the clinical assessment, while the role of the physical examination is limited. An exact and reliable diagnosis may be arrived at through laboratory evaluation, e. g. polysomnography (PSG), Multiple Sleep Latency Test (MSLT), or radiologic examinations. Among conservative treatments, reduction of the body weight is usually effective in mild to moderate cases. In severe apneas, nasal continuous positive airway pressure (nCPAP) is the current treatment of choice. The efficacy of surgical intervention is still controversial. According to most authors, uvulopalatopharyngoplasty (UPPP) has a 50% success rate. Most recently good results have been obtained with maxillo-facial surgery in a variety of selected patients. ]
Lege Artis Medicinae
JULY 27, 1994
[Electrophysiologic study versus electrocardiographic monitoring]
[Both invasive electrophysiological techniques and Holter monitoring are used to assess and predict the efficacy of drug therapy in patients with ventricular arrhythmias. These two modalities were compared in this study, the largest of its kind to date. ]
Lege Artis Medicinae
JULY 27, 1994
[The role of echocardiography in the management of ventricular free wall rupture ]
[Our goal was to evaluate which diagnostic and therapeutic approaches could provide a better chance of survival. Between January 1, 1987, and December 7, 1992, 772 patients with acute myocardial infarction were treated in the Hungarian Institute of Cardiology. Cardiac rupture was investigated by the retrospective analysis of clinical data, electrome chanical dissociation, echocardiographic signs and autopsy findings. Ventricular free wall rupture was found in 28 cases. The diagnosis was confirmed by autopsy in 23, by intraoperative findings in 4 cases, and by echocardiography and pericardiocentesis in 1 case. Pericardial effusion was detected in 12 of 14 cases undergoing emergency echocardiography. Seven of these had pericardiocentesis and 2 patients underwent surgical pericardial fenestration. Following this 4 patients were referred to surgery. All 4 patients died: 2 during and 2 shortly after operation. The bleeding stopped in 1 case, after pericardiocen tesis and continous drainage and during the 12 month follow-up the patient is alive and well. In acute myocardial infarction, electromechanical dissociation or signs of tamponade are indications for emergency echocardiography, and if pericardial effusion can be visualized, pericardiocentesis should be performed. This can lead to a temporary haemodynamic improvement, providing sufficient time for emergency surgery.]
Lege Artis Medicinae
JULY 27, 1994
[Rapid photocopy documentation of histological speciments]
[A simple photocopy technique for histological slide preparations of surgically removed specimens is described. Standard office copy machines may be used for this method which is faster than traditional photography and cheaper than polaroid technique. Significant information is quickly provided by the copies for both the physician and the pathologist, including location and extent of the lesion, the state of its neighbouring structures and the resection margins. Retrospective identification of the tissue sections chosen for histological investigation is also facilitated. Despite some technical limitations, this copy technique may effectively support the diagnostic work of the surgical pathologist.]
Lege Artis Medicinae
JULY 27, 1994
[Pneumocystis pneumonia following kidney transplantation]
[Pneumocystis carinii pneumonia is a rather rare and difficult to prove complication in immunosuppressed patients after organ transplantation. Among 843 transplanted patients the pathogen role of the protozoon came up in 8 and 6 cases during the early postoperative period and later, but it couldn't be proved. In the presented case the performed investigations showed towards Cytomegalovirus (CMV) infection and only the pathohistological examinations led to the correct diagnosis. The histologic examinations did not show characteristic changes to CMV infection. The authors emphasize the importance of etiological diagnosis during the development of non-specific pulmonary clinical signs in predisposed patients by means of induced sputum and/or cytological examination of bronchial lavage or pulmonary biopsy, for adequate therapy and possible recovery.]
Lege Artis Medicinae
JULY 27, 1994
[Letters]
[Stakeholders, conflicts and ways to regulate them in the US health care system; Soup before water.. on food beliefs; What it costs to treat pain in tumour patients]
Lege Artis Medicinae
JULY 27, 1994
[Treatment of maligant tumors with attenuated newcastle disease virus vaccine a phase II trial]
[Newcastle disease virus (NDV) vaccine has been shown to be beneficial in patients with malignancies. The aim of this study was to assess the safety and efficacy of inhaled vaccine. Thirty three patients with therapy-resistant malignant tumors were treated with attenuated NDV/MTH-68 vaccine in an open placebo-controlled (26 patients) trial. The vaccine was administered for 6 months. All patients were considered terminally ill. They received conventional therapy, but cytostatic agents were stopped for 3 months before vaccine therapy. The results were evaluated by changes in size of the tumors and metastases, performance status and subjective parameters. Progression was predominant in the placebo group, subjective parameters also deteriorated, meanwhile in the vaccine-treated group the majority of patients entered a stable disease state or even showed signs of tumor regression. The number of cases with stabilisation or regression was significantly higher in the NDV group. A favourable response in subjective parameters occurred in a significantly higher percentage of the NDV group. The performance status improved in the NDV group and significantly deteriorated in the placebo group. In a small percentage of patients, fever or low-grade fever occurred not necessitating from withdrawal treatment. No other side effects were recorded. This treatment modality is promising and merits further studies. ]
Lege Artis Medicinae
JULY 27, 1994
[When can we consider cardiopulmonary resuscitation?]
[In collaboration with the Royal London Trust, Len Doyal and Daniel Wilsher have developed a set of guidelines for deciding when not to resuscitate a patient. The guidelines describe the procedure to be followed when giving an order not to resuscitate and the clinical, legal and moral criteria that must be met before such a decision can be made. The authors hope that the guidelines will be of assistance to all those responsible for developing criteria for not performing resuscitation in hospitals. ]
Lege Artis Medicinae
JULY 27, 1994
[The Newcastle University medical education system]
[In November 1993, I was invited to join the Institutes of Psychiatry, Neuropsychiatric Rehabilitation, Medical Biochemistry and Health Sciences at Newcastle University Medical School. In addition to all these university institutes, I was able to visit several medical rehabilitation centres, a social welfare centre, a social welfare institute, self-help clubs and a medical library. It was only during my visits that the strategic importance of education, which is fundamentally different from any other university education system I have ever known, became clear to me. ]
Lege Artis Medicinae
JULY 27, 1994
[Hierarchy, responsibility Professional knowledge ]
[Many of the difficulties in the health sector go beyond the confines of the profession itself, and are often social and economic, or social in nature. Before the reader is alarmed, I do not intend to spend two pages analysing this voluminous range of problems. However, it is worth highlighting an issue in the pages of a professional journal, if only because some of them are mainly professional in nature, yet have become part of political debates and events.]
Lege Artis Medicinae
JULY 27, 1994
[Can the ticking time bomb be defused?]
[The third criterion for the choice of therapy; What can the health insurer do; Health economic evaluation ]
Lege Artis Medicinae
JULY 27, 1994
[Law, morality, ethics and livelihoods]
[Respect for human rights, including patients' rights, plays an increasingly important role in our democratising public life. The scarce distribution of resources and the low salaries of health workers are leading to new and increasing moral and ethical conflicts, both for individual doctors and for the medical profession as a whole. It is therefore no coincidence that recently the Ethics College of the MOC has been forced to amend some of its positions, and that the two most important medical clubs - the LAM Club and the Liberal Medical Club - have chosen to address current issues of medical ethics.]
Lege Artis Medicinae
JULY 27, 1994
[National game fund]
[The list of applicants who have been awarded non-refundable or refundable grants from the Fund, based on a decision of the Minister of Finance, following a proposal by the National Games Council at its meeting in March 1994, is set out below.]
Lege Artis Medicinae
JULY 27, 1994
[Écorché]
[The Louvre in Paris preserves a drawing by Bartolomeo Passarotti (1539-1592) from Bologna, entitled "Michelangelo's Boncol" or "Anatomy Lesson for Artists", from around 1570, which is one of the most important sources of images for the research on anatomy that developed rapidly in the 16th century. In the foreground of the drawing, Michelangelo lectures to painters and sculptors in front of a half-sitting, half-lying corpse. To the right of them, in the background, a particular anatomical sculpture, the écorché (e: écorse), is used as a visual aid. ]
Lege Artis Medicinae
JULY 27, 1994
[Communicating the diagnosis of terminal illness and the relationship to your own death]
[The issue of communicating a medical diagnosis is becoming increasingly publicised. It is not only the literature that deals with this topic, but also the various mass media (daily press, radio, television, etc.) that can inform the public about different opinions. ]
Lege Artis Medicinae
JULY 27, 1994
[Nursing during the War of Independence]
[After the appointment of the first responsible Hungarian ministry in the spring of 1848, it became possible to create new forms of health care governance, to establish offices for each of the country's tasks, and to create a framework for practical patient care. The latter was primarily linked to the organisation of the medical service of the army, and included the question of hospitalisation.]
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