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Lege Artis Medicinae - 1994;4(12)
Content
Lege Artis Medicinae
DECEMBER 28, 1994
[Is pay for performance a viable option in the health sector?]
[After reviewing our department's employment statistics a few weeks ago, I was not surprised to see that we have performed almost twice as many radiology examinations in the past year as the Royal College of Radiologists' recommended number of examinations. Since 1990, the number of outpatient examinations in our department has increased by 48%, the number of inpatient examinations by 13% and the number of accident and emergency examinations by 6%. Most other specialists could report similar figures.]
Lege Artis Medicinae
DECEMBER 28, 1994
[The first 15 years of the AIDS epidemic ]
[AIDS represents the most exciting infectious disease of the last 15 years. In addition to the fact that there are more than 4 million estimated AIDS patients and more than 16 million estimated HIV-infected individuals this can be explained by the peculiar features of the disease, including limited routes of infection, long latency period, a quasi 100% lethality, diversity of the clinical picture, difficulties in therapy and vaccination, the theoretically 100% possibility of prevention and the serious social problems associated with AIDS. After giving a short review of the development of our knowledge about AIDS, the author to explains the special features of AIDS mentioned above on the basis of the structure, regulation and replication cycle of the virus. The primary conclusion is that education and prevention should be stressed in the battle against AIDS.]
Lege Artis Medicinae
DECEMBER 28, 1994
[The role of transesophageal echocardiography in the investigation of stroke]
[Ischaemic infarction accounts for 85% of stroke aetiology (1). Approximately 60-70% of these are of cerebrovascular, i.e. carotid arteriosclerosis, origin (2). The proportion of cardiogenic embolism was previously estimated at 15% (1), but autopsy data suggest that embolism is the cause of half of fatal strokes (3). There are two reasons for this large discrepancy: 1) the intracardiac source is difficult to identify in vivo; 2) cardiogenic embolism has a more severe outcome than stroke of other origin. Probably both are true, but there is no doubt that before the introduction of transesophageal echocardiography (TE), the detection of intracardiac sources was rare and uncertain.]
Lege Artis Medicinae
DECEMBER 28, 1994
[A multicentre, randomised, crossover, double-necked trial of contamination of conventional and bow-tie dressings in routine obstetric and gynaecological practice]
[In the 19th century, the usual dress of doctors was a small bow tie tied in a flat knot "once round" in addition to a stiff standing collar (1). As fashions have changed, the wearing of bow ties has become less common and is now worn almost exclusively by a small minority of obstetricians, who often claim that they are more hygienic than the traditional tie in the delivery room, which is contaminated with blood and amniotic fluid. There is currently no evidence for this. We therefore examined the contamination of traditional and bow ties worn by obstetricians during a typical working week. ]
Lege Artis Medicinae
DECEMBER 28, 1994
[Clinical and laboratory parameters in ulcerative colitis]
[The clinical and laboratory parameters which correlate with the intensity of the inflammatory process in ulcerative colitis patients were analyzed in this study. The severity of the inflammatory process was assessed with leukocytescinti graphy by colorectal segments using a scoring method in 36 patients (group A). The sum of the segmental scores were considered to represent the intensity of the inflammatory process and were compared with clinical and laboratory parameters. From among the 36 patients, acute ulcerative colitis was established with biopsy in 30 cases. Two toxic patients were not tested and four patients had inactive disease. In 20 (16 acute, 4 inactive) of 36 patients, the intensity of the inflammatory process was assessed by segments with score values of biopsy samples and leukocyte scintigraphy (group B). The sum of the score values was used to determine the correlation of the two methods. The intensity of the inflammatory process assessed by scintigraphy showed a good correlation (r = 0.6564, p = 0.0016) with histological findings (group B), as well as with the ESR (r = 0.6398), serum fibrinogen (r = 0.5424), alfa2 globulin level (r = 0.4721), number of bloody stools (r = 0.4605), and the thrombocyte count (r = 0,4594) in group A. Five clinical and laboratory parameters proved to be suitable to assess the actual severity of the inflammatory process in ulcerative colitis. The values of the parameters may help to choose the right examination in new cases and to evaluate the efficacy of the therapy. ]
Lege Artis Medicinae
DECEMBER 28, 1994
[Prenatal diagnosis of endocardial fibroelastosis]
[The authors report two cases of prenatally diagnosed endocardial fibroelastosis with echocardiography for the first time in Hungary. This disease is rare and usually fatal. Diagnoses were confirmed by autopsy and in one case by postnatal echocardiography as well. Principles for the diagnosis of endocardial fibroelastosis are discussed. Echocardiography makes possible the prenatal diagnosis of endocardial fibroelastosis and is recommended from the 18th week of pregnancy in high risk individuals.]
Lege Artis Medicinae
DECEMBER 28, 1994
[News]
[At the initiative of the International Union Against Cancer (UICC), the World "Don't Grow Up" Day was celebrated on the third Thursday of November in several countries. The idea - to get as many people as possible to give up cigarettes for good on a specific day of the year, supported by the media and cessation services - started in the United States 20 years ago in 1974. ]
Lege Artis Medicinae
DECEMBER 28, 1994
[Tuberculosis surveillance epidemiological data from hungary in contrast of european trends]
[In the last fifteen years the favourable trends of tuberculosis epidemy has turned back in most European countries. This phenomenon and the vast migration of population provided the necessity, while the development in microbiology, immunology and informatics made possible to transform the previously successfull surveillance systems adopting new, up-to-date methods and technology. This has been performed in many Western and Middle European countries. The following facts has been established (1) The increasing of incidence is connected mainly to migration and HIV epidemy (2) New, exogeneus infections play major role in the pathogenesis of tuberculosis than it has been previously supposed (3) Microepidemics and polyresistent infections are the characteristic elements of epidemy. In the trends of tuberculosis epidemy in Hungary similar features can be recognized as in Western Europe (the increasing of incidence and its shift towards younger age groups etc.). To identify factors in the background of this phenomenon, following methods should be integrated into the surveillance system: (1) Centralized, individual, computer processed notification (2) Triple notification system (clinical, bacteriological, post mortem) (3) Compulsory screening of foreigners (4) Full scale sensitivity testing and adaptation of high technology microbiological methods (5) Intensive tracing of contacts and sources of infection. Preventive and therapeutical consequences: (1) Protection of health care staff (2) Isolation of infectious (mainly multidrug-resistant) cases (3) Wide scale application of fully supervised chemotherapy (4) Consistent performance of traditional patient care methods. Epidemiological and surveillance data from Western Europe and Hungary are reviewed to demonstrate the subject. ]
Lege Artis Medicinae
DECEMBER 28, 1994
[Computer assisted diagnostics of malformation syndromes promotes interdisciplinary cooperation between clinical specialities]
[Experiences obtained from the diagnostic work up of 44 malformation syndrome cases using four computer assisted diagnostic programmes is presented. This method, in addition to many other advantages, significantly improves the diagnostic possibilities in these very rare cases, and may further promote the interdisciplinary cooperation between various clinical specialities.]
Lege Artis Medicinae
DECEMBER 28, 1994
[Early sources of the hungarian history of eating disorder]
[The authors review the early Hungarian descriptions and development of anorexia (nervosa). Among the medieval fasting saints, the ascetic eating disorder of Princess Margaret of Hungary is discussed and the anorectic characteristics of Empress Elizabeth from the 19th century are also presented. The entry of this disorder into the international medical common knowledge may be placed at the end of the 19th century, with the most authentic descriptions being published in 1873. On the basis of Hungarian sources, it appears that the phenomenon of anorexia is mentioned by publications which appeared at the turn of the century. A certain overlapping of the diagnosis of anorexia and tuberculosis which was a widespread disease at that time should be emphasized. In early studies, mental causes of the emaciation are generally dicussed, especially hysteria. It should be underlined that, until the fifties, relatively little data relates to the Hungarian situation of anorexia. The first Hungarian case report of anorexia was published in 1955, although not under the name of anorexia, and without mentioning the role of mental factors. The authors emphasize the significance of medical history research in psychiatry and in psychosomatic disorders. In this respect, anorexia nervosa is a paradigmatic disorder: changes in its history reflect well the characte ristic situation of psychiatry in each period of time, and may provide a basis for modern therapeutical strategies. ]
Lege Artis Medicinae
DECEMBER 28, 1994
[Experiences in the first year of the new hospital funding - changes hoped for and those that have actually happened]
[As of 1 July 1993, the new hospital financing system in Hungary, the active inpatient care, introduced a performance-based accounting system according to DRGs instead of the previously used resource allocation based on predetermined input budgets using simple planning methods. The efficiency and the fundamental impact of the new hospital financing on the quality of the health care system and patient care cannot be dissociated from the characteristics of other areas of the health care system. The basic regulatory effect is the structure of the health service delivery system, the role of each provider in patient care and the extent of the responsibility that this role entails. ]
Lege Artis Medicinae
DECEMBER 28, 1994
[Outlines of the 1995 budget of the Health Insurance Fund]
[An odd title... you may think, dear reader, when you come across this article in the December issue. It should be about the budget, not its conditions. On this subject, perhaps optimistically, the law on public finances stipulates that budget bills must be submitted to Parliament by 30 September. ]
Lege Artis Medicinae
DECEMBER 28, 1994
[The timetable for studying the medical literature]
[We are all aware that it is impossible to keep up with the medical literature. (The fault is not in the publications, but in the authors, who are multiplying exponentially.) At the same time, everyone has an acquaintance who (claims to be) up to date with the literature.]
Lege Artis Medicinae
DECEMBER 28, 1994
[Stocktaking and vision]
[Obviously something like this would be needed. In the Hungarian health sector too. And in society. And then both together. Because the realisation is spreading, albeit slowly, that the health of the people is not decided in the health sector, but in society. In lifestyle, culture and human relations. The health system is barely able to reduce the risks to health, and is tired of dealing with the damage. And they are growing.]
Lege Artis Medicinae
DECEMBER 28, 1994
[János Szentágothai]
[János Szentágothai, the Hungarian and international a world-renowned leader in neuroscience, died unexpectedly on 8 September. His death was not preceded by a long illness. Before his death, he was working on the manuscript of his book on the general principles of the nervous system. Although he was unable to complete this book in its entirety, his life, this ambitious career, can be considered complete, if not finished. ]
Lege Artis Medicinae
DECEMBER 28, 1994
[Lege Artis Litterarum]
[We have an unusual compilation for you, Dear Reader! As a thank you for taking the time to read our newspaper in the excitement of the run-up to Christmas or in one of the quiet moments following the festive season, we invite you to enjoy a quality break. Lege artis litterarum, the rules of the art of literature, are reflected in the following pages. Sometimes ironically about our irrefutable omniscience, our infallibility, sometimes poignantly about our weaknesses and failures. Weeds, fevers, dreams - short stories, dramas, poems. Molière, Karinthy, Chekhov, Márai are calling you now, so make yourself comfortable and join us!]
Lege Artis Medicinae
DECEMBER 28, 1994
[About the Birth of Jesus altar in Lőce]
[It's Advent, and everyone is thinking ahead to Christmas. In churches, under Christmas trees, bethlehem scenes are set up, a group of statues that not only recall but literally embody the people who were present on that night in Bethlehem, almost two thousand years ago, when the baby Jesus was born.]
Lege Artis Medicinae
DECEMBER 28, 1994
[Communication aspects of the "informed consent" principle]
[The concept of informed consent is becoming increasingly common in modern medical ethics. "Informed consent is the voluntary, free and informed authorization given by a patient to the physician to perform a planned procedure. The principle is a new model of communication in the doctor-patient relationship, in which the doctor involves the patient in the decision-making process and the patient, with the help of information from the doctor, decides for himself which of the possible diagnostic or therapeutic alternatives should be applied to him."]
Lege Artis Medicinae
DECEMBER 28, 1994
[One of the oldest forms of health education literature, the calendar]
[For centuries, the almost sole source of knowledge for the poorly educated common people has been the timetable and the calendar. In this popular publication they could find all the information they needed to answer the problems and questions they faced in their daily lives. ]
1.
Clinical Neuroscience
[Headache registry in Szeged: Experiences regarding to migraine patients]
21. MAY
2.
Clinical Neuroscience
[The new target population of stroke awareness campaign: Kindergarten students ]
21. MAY
3.
Clinical Neuroscience
Is there any difference in mortality rates of atrial fibrillation detected before or after ischemic stroke?
27. NOV
4.
Clinical Neuroscience
Factors influencing the level of stigma in Parkinson’s disease in western Turkey
27. SEP
5.
Clinical Neuroscience
[The effects of demographic and clinical factors on the severity of poststroke aphasia]
18. JUL
1.
2.
Clinical Oncology
[Pancreatic cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up]
29. AUG
3.
Clinical Oncology
[Pharmacovigilance landscape – Lessons from the past and opportunities for future]
29. AUG
4.
5.