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Lege Artis Medicinae - 1994;4(08)
Content
Lege Artis Medicinae
AUGUST 31, 1994
[Catheter ablation of supraventricular tachycardias]
[Medical therapy for supraventricular arrhythmias is often ineffective. Arrhythmia surgery is limited by its considerable morbidity and cost. A better understanding of the exact anatomic-electrophysiologic correlations that govern supraventricular arrhythmogenesis and the advances in catheter ablative techniques have led to a new, effectual and costeffective therapy. Catheter ablation techniques result in a high rate of success rates and a low rate of complications. Radiofrequency ablation has become an accepted form of treatment for a variety of supraventricular arrhythmias. This review summarizes current data on catheter ablation of supraventricular arrhythmias.]
Lege Artis Medicinae
AUGUST 31, 1994
[The role of langerhans' cells in the development of cervical cancer]
[While the number of deaths from cervical cancer of women over the age of 45, has fallen in the recent years the mortality in women under the age of 35 has increased. The reason for this change is not clear. A large number of analytical studies tried to identify the risk factors for cervical cancer (age, marital status, time of first intercourse, number of sexual partners, coital frequencies, circumcision of partners, menstrual patterns, gravidity, type of contraception, smoking, viral infection, socioeconomic circumstances) but the real con nection between the disease and the varions risk factors remained unclear. The results of these studies suggest that, the 'one hit one tumor' hypothesis can't be proven, and it seems more appropriate to cousider a complex effect of these etiologic factors acting on the altered immunologic status of the cervix uteri. We tried to concentrate on one out of these factors from the literature which may play a cardinal role in the development of CIN or invasive cervix cancer. It is evident from the literature that the macrophages present in the cervix tissue in CIN, or infiltrating the tumor tissue in invasive cancer, could influence either the development of cervical cancer or the prognosis of the disease. It has long been known that in the cervical tissue there are a specific type of dentric cells taking part in the antigen presentation process. The examination of behavior, distribution and activity of these so – called Langerhans cells due to the exogen effect in the cervical tissue may be a which contributes to the understanding of the process leading to the development of CIN. ]
Lege Artis Medicinae
AUGUST 31, 1994
[Morbidity of ischemic heart disease in early breast cancer patients 15-20 years after adjuvant radiotherapy]
[Our aim was to assess the frequency of cardiac side effects, primarily ischemic heart disease, in symptom-free patients with early breast cancer previously treated with radio therapy. Thirty-seven survivors of a previous randomized study of early breast cancer were examined. Twenty patients irradiated pre- or postoperatively for left-sided disease (study group patients) were compared with 17 controls who were either treated for right-sided disease, or were non-irradiated patients. Radiotherapy was randomized in the original study; either tangential field Co-, or electron-therapy was delivered. A bicycle ergometry stress test with 99m Tc Sesta MIBI myocardial perfusion scintigraphy was carried out and the patients' major risk factors for ischemic heart disease were also listed. Our results showed a significant difference between the scintigraphic findings of the two groups. Five of the 20 study group patients (25%), and none of the 17 controls exhibited some kind of significant defect on scintigraphy, indicating ischemic heart disease (p <0,05). Radiotherapy for left-sided breast cancer with the above-mentioned treatment technique may be an independent risk factor in the long-term development of ischemic heart disease. The need to optimize adjuvant radiotherapy for early breast cancer by considering the dose both to the heart as well as the cancer, is emphasized. ]
Lege Artis Medicinae
AUGUST 31, 1994
[The role of baseline duplex sonographic examination in monitoring the transplanted kidney in the early postoperative period]
[Routine baseline duplex sonography and sonographic monitoring have been performed afer kidney transplantation at our University since November, 1992. Data on 24 patients are analysed. Baseline sonograms were assessed as normal in 18 patients. Abnormalities involved collecting system dilatation, and swelling of the parenchyma. In every case in which the transplanted kidney had to be removed because of serious complications, we observed morphological changes in the follow-up examination. The resistance index (ARI) measured during duplex Doppler examinations was higher than 75% in 8 of the 24 cases. Four of these grafts had to be removed. From among the 16 cases having normal baseline RI, only 2 kidneys were lost during the postoperative period. Baseline and follow-up duplex sonographic examinations were found to have an important role in the management of kidney transplanted patients. Early complications can be detected, therapy can be initiated in time, and the changes occurring during follow-up can be evaluated more sensitively. ]
Lege Artis Medicinae
AUGUST 31, 1994
[Recovery from persistent vegetative state of four months or more]
[A retrospective study was carried out on 43 patients admitted to a ward specifically designed for the rehabilitation of patients with persistent vegetative states after another. Of these, 11 regained consciousness four months or more after brain injury. It was reported that the patients' first reaction to being able to follow with their eyes was between the 4th month and the 3rd year of the condition, while the first reaction to being instructed was between the 4th and the 12th month. Only one patient was unable to communicate, six used non-verbal means to express at least yes and no, four could speak. Six patients required full care, while two became independent in their daily activities. Four patients were able to eat independently, three needed assistance, and four patients required maintenance of gastric tube feeding.]
Lege Artis Medicinae
AUGUST 31, 1994
[Ischaemic heart disease caused by radiotherapy and its prevention]
[A review of retrospective clinical studies demonstrates the cardiac damaging effects of chest wall radiotherapy (1, 2, 3). Therefore, the interesting study published in this issue of LAM, which draws attention to a specific late complication of mammary tumour radiotherapy, namely possible coronary damage, is welcome (4). ]
Lege Artis Medicinae
AUGUST 31, 1994
Lege Artis Medicinae
AUGUST 31, 1994
[GISSI 1]
[To determine whether i.V. streptokinase treatment in acute myocardial infarction reduces in-hospital and 1-year mortality, whether the expected effect is related to the time between the onset of pain and the start of treatment, and the risk of therapy.]
Lege Artis Medicinae
AUGUST 31, 1994
[News]
[We want to live a long time, but no one wants to grow old; 1995 Annual General Meeting of the Scientific Society for Public Health]
Lege Artis Medicinae
AUGUST 31, 1994
[Thrombolysis in myocardial infarction phase I]
[Comparison of the efficacy of rt-PA and streptokinase treatment in acute myocardial infarction in terms of coronary artery opening and side effects in the ischemic territory. ]
Lege Artis Medicinae
AUGUST 31, 1994
[Long-term care problems for patients with persistent vegetative states]
[Doctors responsible for the care of patients with persistent vegetative states face a wide variety of problems. For example, whether artificial feeding should be considered therapy or care, whether it is an acceptable part of treatment to stop artificial feeding, the clinical benefit of active treatment, the level of consciousness at which a patient can be said to have a good quality of life, and who determines the patient's right to die. These questions are determined more by social, legal, emotional, cultural, religious and economic factors than by the clinical picture.]
Lege Artis Medicinae
AUGUST 31, 1994
[Patients with persistent vegetative states]
[The ultimate moral goal of medicine, which doctors and health professionals have insisted on since Hippocrates, is to provide the patient with a medically pure benefit in a way that does the least harm. Today, we can add to the Hippocratic goal the moral constraint that this principle must be pursued in a way that respects people's freedom of choice and is just and fair to others (whether it is the allocation of scarce resources, human rights, or respect for moral law).]
Lege Artis Medicinae
AUGUST 31, 1994
[Five years of graduate nursing education at the Imre Haynal University of Health Sciences, Faculty of Health Sciences]
[The authors review the history of the then Postgraduate Medical School, now Imre Haynal University of Health Sciences, the first in Hungary to establish a Diploma in Nursing at the Faculty of Health Sciences. The social conditions, the framework and methods of training are described. They evaluate their activities and outline their ideas for educational development in the light of the changes in the health care system.]
Lege Artis Medicinae
AUGUST 31, 1994
Lege Artis Medicinae
AUGUST 31, 1994
[New ways forward in hospital cost-performance planning]
[In recent years, there have been significant changes in the internal and external environment, which have affected hospitals on a wide scale and at several points simultaneously. Adapting to the environment and responding to its challenges has become a fundamental task. If reference is made to the theoretically accepted process that environmental change must lead to strategic change and then to the creation of an organisation adapted to the objectives set out in this change, then a fundamental prerequisite is to map the environment thoroughly, to monitor changes and to assess possible trends. ]
Lege Artis Medicinae
AUGUST 31, 1994
[Piano music to fight insomnia]
[More than 250 years ago, in 1742, the fourth piece in J. S. Bach's Klavierübung series, the "Aria mit verschiedenen Veraenderungen vors Clavicimbal mit 2 Manualen" (1), was published. This monumental work, which contains 30 variations, is a direct and symbolically rich work. indirect medical implications, so it is perhaps worthwhile to briefly examine the circumstances of its creation, its artistic value and the way it is performed.]
Lege Artis Medicinae
AUGUST 31, 1994
[Patient rights in some foreign hospital laws]
[The welfare government is preparing a law on hospitals. This will certainly include patient rights that are already partly covered by the existing Health Act and other legislation (medical confidentiality, data protection, referral of psychiatric patients, compulsory treatment, etc.). However, many of these need to be updated and others need to be codified. The new Hospital Act should also bring the existing lower level legislation into law. ]
Lege Artis Medicinae
AUGUST 31, 1994
[Oscar knows but won't say...]
[With a lucky hand, the organisers have set the season-closing LAM Club meeting on a juicy date. The invitation announced that the future Minister of Welfare would be among the guests. Not only was he present, but, as we shall see, so were the most important personalities shaping health policy in the near future. On this day - the day of the signing of the coalition agreement between the MSZP and the SZDSZ - everyone knew exactly who would be assigned to what function, and they asked and answered questions with this in mind, but the host, the invited MP and the members of the very distinguished group of guests accepted as a tacit rule that they knew what they knew, but they would not say. As a result, we were able to participate in a good-humoured, genuinely friendly meeting, not lacking in declarations, without any circle of honour, but with responsible words and then accountable statements.]
Lege Artis Medicinae
AUGUST 31, 1994
[Chamber of Pharmacists Act after 120 years]
[The Act on the Hungarian Chamber of Pharmacists entered into force on 6 June 1994. Although the Hungarian Pharmaceutical Society has been trying for 120 years, it has never had a self-government with public body powers. The 15 attempts to date, which have resulted in 15 draft laws, have failed, sometimes because of the outbreak of world wars, sometimes because of opposition from the medical profession.]
Lege Artis Medicinae
AUGUST 31, 1994
[Data on the uptake of smallpox vaccination in Hungary]
[One of the great discoveries of modern medicine, the smallpox vaccination method of Eduard Jenner (1749- 1823), which was used to control smallpox, which originated in Asia and can be traced back almost to antiquity. Smallpox epidemics, although not comparable in devastation rates to other ancient and medieval epidemics, are found in our almost ancient medical history, and the methods of control - variolisation - are also known from Greco-Roman, Arabic and medieval accounts.]
Lege Artis Medicinae
AUGUST 31, 1994
[Baths of the Dürer period]
[Cleaning, and occasionally bathing, is a constant need for people of all ages. In a more civilised, urban environment, this is becoming increasingly important, as people living in more crowded conditions are more aware of the need for it and less satisfied with rudimentary solutions than primitive peoples or villagers.]
Lege Artis Medicinae
AUGUST 31, 1994
[Restrictions on the right to self-determination in healthcare]
[The principle of autonomy seems to have been definitively incorporated into the basic principles of bioethics and medical law, which were nurtured on moral philosophy. It is a fundamental requirement of informed consent, of participation in biomedical interventions, but - and this is where this paper begins - it is never absolute or unique among the principles that, in both theoretical and litigation disputes, would encompass the totality of the legal relationship between doctor and patient, and all its contentious issues.]
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