Lege Artis Medicinae - 2000;10(03)

Lege Artis Medicinae

MARCH 01, 2000

[The role of coronary artery revascularization in the management of heart failure and systolic left ventricular disfunction]

LENGYEL Mária

[Ischemic heart disease accounts for about 70% of chronic systolic heart failure and severe systolic left ventricular dysfunction. Prognosis of ischemic heart failure is worse than that of non-ischemic heart failure and can only be moderately improved with optimal drug treatment. Further improvement may be expected from revascularization in the presence of reversible left ventricular dysfunction which is called myocardial viability. Viability associated with chronic left ventricular dysfunction is caused by hibernation. Low dose dobutamine stress echocardiography is the best imaging modality to predict the improvement of left ventricular function after revascularization. Myocardial contrast echocardiography can further improve the diagnostic value of dobutamine echocardiography. The disadvantage of nuclear imaging methods for the diagnosis of viability is their low specificity. Revascularization surgery improves left ventricular function and survival when the amount of viable myocardium is adequate. However, the non-revascularized viable myocardium is an unstable condition which can effect the prognosis adversely. Although there are no randomized studies, coronary bypass surgery is considered indicated for severe left ventricular dysfunction if the viability of the myocardium and the operability of the coronary arteries are estabilished, even in the absence of angina. To establish these criteria for revascularization imaging studies (preferably low dose dobu tamine stress echocardiography) and coronary angiography are required. ]

HUN 2000;10(03)

Lege Artis Medicinae

MARCH 01, 2000

[Action on Secondary Prevention through Intervention to Reduce Events]

MATOS Lajos

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HUN 2000;10(03)

Lege Artis Medicinae

MARCH 01, 2000

[The microbiology pharmacokinetics and clinical use of carbapenems]

BÁN Éva, PRINZ Gyula

[ Imipenem and meropenem the two currently available carbapenems inhibit the synthesis of the cell wall similarly to other bactericidal B-lactam antimicrobials. These agents have excellent activity against the vast majority of aerobic and anaerobic Gram-positive and Gram-negative organisms. In addition to other B-lactam resistant microbes (e.g. Chlamydia, Mycoplasma) only Stenotrophomonas maltophilia and Enterococcus faecium bacteria are naturally resistant to carbapenems. Carbapenems are extremely stable compounds against nearly all types of B-lactamases: from the penicillinase of Staphylococcus to Class A and Class B types of B-lactamase enzymes of Gram-negative bacteria. Secondary resistance against carbapenems was described in case of the following bacteria: penicilline resistant S. pneumoniae, methicilline resistant Staphylococcus aureus, Pseudomonas aeruginosa, Enterobacter cloaceae, less frequently Enterobacter aerogenes, Serratia mercescens, Klebsiella pneumoniae and Acinetobacter baumannii. The pharmacokinetic profile of imipenem and meropenem are very similar. Carbapenems are valuable as empirical monotherapy due to their broad spectrum of antimicrobial activity and ß lactamase stability in the treatment of severe nosocomial infections, lower respiratory tract or intraabdominal infections and febrile neutropenia. The use of imipenem in central nervous system infection is not approved due to the high incidence of seizures. ]

HUN 2000;10(03)

Lege Artis Medicinae

MARCH 01, 2000

[Confined placental mosaicism and uniparental disomy]

BODA Anikó, PAPP Zoltán

[Chromosomal mosaicism is defined as the presence of two or more cell lines having different chromosomal complements in the same individual. In the conceptus the extent of the mosaicism depends on the timing of chromosomal mutation occurance, the cell lineage affected, and the viability of the mutation. The resultant mosaicism can be either generalized, confined placental or confined embryonic. The process of the loss or removal of one of the three chromosomes from the trisomic conception, at least from the cells that will form the proper fetus is known as trisomic zygote rescue. As the result of this phenomenon, the embryo/fetus becomes disomic, while the placental compartment remains trisomic or mosaic. After losing a chromosome, the remaining pair might originate from the same parent. The presence of two chromosomes from one parent in a disomic cell line is termed uniparental disomy. Uniparental disomy is one form of aberrant origin for disomic cells, and the term „pseudodisomy" is also used. Uniparental disomy can involve homozygosity for the chromosome, and the term ,,isodisomy" has been suggested for this phenomenon. If the homozigosity for the chromosome is not complete, the term „heterodisomy" is used. Depending on the pathologic chromosome, the clinical consequences of the confined placental mosaicism and uniparental disomy can be intrauterine and/or postnatal growth restriction, spontaneous abortion. Increased perinatal morbidity and mortality, minor congenital malformations can result from the phenomena. Confined placental mosaicism and uniparental disomy are well known in syndromatology too. The connections of mosaic trisomy 7 and Silver-Russell syndrome, mosaic trisomy 15 and Angelman syndrome, mosaic trisomy 15 and Prader-Villi syndrome are described. Due to the presence of aneuploid cells in the placenta, confined placental mosaicism may cause placental dysfunction, hydropic degeneration of the placenta or „unexplained" highly increased serum hCG level. ]

HUN 2000;10(03)

Lege Artis Medicinae

MARCH 01, 2000

[Home management of chronic obstructive pulmonary disease]

MÜHLBACHER Szilvia, VADÁSZ Imre

[Cessation of smoking is the primary condition for the successful management of COPD. The aim of pharmacotherapy is to diminish symptoms (dyspnoe, cough and expectoration) to increase cardiorespiratory performance and to improve the quality of life. Pharmacotherapy is based upon administration of bronchodilators (anticholinergic and beta-agonist preparations as well as theo phyllin). In the case of acute exacerbation anti- biotic treatment is indicated. Effectiveness of inhalative corticosteroids is not established well yet, whereas the oral and parenteral administration of corticosteroids is limited by severe side effects. In the advanced stage of disease long term oxygen therapy can increase survival and improve the quality of life. Respiratory rehabilitation is an essential component in the management, it facilitates expectoration and corrects respiratory technique, increases muscular force and performance, improves quality of life. Active cooperation of patients is necessary for the successful management of the desease; the patient should be informed on the particulars of the disease and on the required contribution.]

HUN 2000;10(03)

Lege Artis Medicinae

MARCH 01, 2000

[Why are there more asthmatic children?]

ENDRE László

[Data for prevalence of asthma in children are presented from different countries of the world in 1998 and 1999. The disease is observed very frequently everywhere. Prevalence of asthma in children in Budapest increased from 1,88+0,87% to 2,26+0,95% between 1995 and February of 1999, as diagnosed by medical doctors. The increased prevalence (20%) could not be explained with the worsening of the city's air pollution (NO2, CO2, CO, ozone and particulate matter), or with the considerable increase of the pollen count of allergising plants. During the same 4 years the number of live births in Hungary decreased by 13%. The author discusses a few factors that may play an important role in the increasing frequency of asthma, and gives recommendations for slowing down the trend.]

HUN 2000;10(03)

Lege Artis Medicinae

MARCH 01, 2000

[ Leaflet; Breathing exercises were started for people with obstructive pulmonary disease]

SEBESINÉ Sikter Margit

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HUN 2000;10(03)

Lege Artis Medicinae

MARCH 01, 2000

[Scientific Browser]

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HUN 2000;10(03)

Lege Artis Medicinae

MARCH 01, 2000

[Moderate alcohol consumption reduces the risk of coronary heart disease: a meta-analysis of effects on lipids and coagulation factors]

RIMM B. Eric, WILLIAMS Paige, KERRY Fosher, MICHAEL Criqui, MERIL J. Stampfer

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HUN 2000;10(03)

Lege Artis Medicinae

MARCH 01, 2000

[Cancer Screening Recommendations in the United States]

JÓNÁS Eszter

[At the Cancer Institute (NCI) in the summer of 1999, I attended a course on Tumor Prevention and Control, which focused on primary and secondary tumor prevention options. The course had 15 foreign and the same number of American students. All continents except Australia were represented in the international group. While foreign students were (with one exception) doctors, in the case of American participants, in addition to the 20% proportion of doctors, the rest came from nurses, biologists, chemists, sociologists, mathematicians working in the field of prevention. What was said was divided into eight topics. The first was titled Tumor and Statistics. In this module, we are introduced to the basic concepts of biostatistics as well as some health surveys that have been successful in America for decades. In the second part, we get a summary of the biometric methodology. The third topic was Genetics and Tumor Biology. Here we could hear about oncogenes and suppressor genes as well as hereditary tumors. The fourth working group dealt with the prevention and control of the most common and high-mortality tumors. In the fifth part, we heard about diet and chemoprevention. There has been talk of foods that promote the development of certain tumors or that inhibit this process. A separate lecture was given on the role of herbs in the prevention of tumor formation. The sixth topic was entitled Special Populations and the Environment. They pointed out the decisive role of the environment in the development of cancer. The seventh topic dealt with the possibilities of disseminating health protection and lifestyle reform. Not only were we able to learn about the theoretical possibilities of popularization, but we were also able to learn about some successful American programs. The final section provided information on ongoing tumor prevention and control research at NCI.]

HUN 2000;10(03)

Lege Artis Medicinae

MARCH 01, 2000

[ Excerpts from publications of Hungarian authors published in foreign journals]

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HUN 2000;10(03)

Lege Artis Medicinae

MARCH 01, 2000

[ Hungarian health care: diagnosis and therapy]

NAGY András László

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HUN 2000;10(03)

Lege Artis Medicinae

MARCH 01, 2000

[Right to refuse care and blood transfusion]

CSAPODY Tamás

[The importance of ritual abstinence from blood is believed by many and the benefits of medical interventions without blood transfusions are already known. Rejection of blood transfusions has also become an important issue because members of the increasingly populous religious group of Jehovah’s Witnesses share this view worldwide.]

HUN 2000;10(03)

Lege Artis Medicinae

MARCH 01, 2000

[ Health Law, Patient Rights, and the Experience of Jehovah's Witnesses]

HARASZTI Zoltán

[According to Article 54 of the Constitution: “Every person in the Republic of Hungary is born he has the right to life and human dignity, from which no one shall be arbitrarily deprived. " Everyone has the right to the full enjoyment of the human dignity in the event of any illness or medical intervention. From the fundamental right of human dignity, the prohibition of all medical and health interventions that disregard the personality of the patient can be deduced.]

HUN 2000;10(03)

Lege Artis Medicinae

MARCH 01, 2000

[Books; Suffering, sympathy, solidarity]

BLASSZAUER Béla

[ Jos V. M. Welie’s book (In the face of Suffering. USA, Creighton University Press, 1998.) is about the applied field of bioethics, the philosophical-anthropological foundation of clinical ethics. The Dutch author, who lives in the United States, makes great use of his medical, legal and philosophical qualifications. Mainly the latter, with which it analyzes and sheds light on the philosophical background and context of clinical ethics. When analyzing basic bioethical concepts, he refers to and often quotes the works of Heidegger, Sartre, Camus, Marcel, Scheler, Mounier, Freud, and Hume, the thoughts of ancient philosophers, and from the work of contemporary bioethicists.]

HUN 2000;10(03)

Lege Artis Medicinae

MARCH 01, 2000

[ Fine arts; Biography of Constantijn Huygens]

BALOGH Tamás

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HUN 2000;10(03)

Lege Artis Medicinae

MARCH 01, 2000

[Doppler or dopler?]

GRÉTSY Zsombor

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HUN 2000;10(03)

Lege Artis Medicinae

MARCH 01, 2000

[Historica Medica; Data from the history of domestic urology]

KAPRONCZAY Károly

[Until the first third of the 19th century, the science and practice of surgery encompassed all interventions that formed “external” diseases on the body surface, resulted from injuries, and rarely underwent abdominal interventions. True, the unresolved issue of pain relief, the risk of wound infection, has set a limit in this regard. Ophthalmology, for example, was practiced within surgery, and separate ophthalmology departments and clinics were separated from surgical departments only from the 1810s, although they remained in a long-dependent relationship with general surgical clinics. From these years onwards, the sectors covering a narrower range of surgical disciplines became increasingly different from surgery. Among the now large number of independent surgical professions, urological surgery can still show great results.]

HUN 2000;10(03)

Lege Artis Medicinae

MARCH 01, 2000

[V. Debrecen Cardiology Days]

CZURIGA István, BARCZI Judit

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HUN 2000;10(03)

Lege Artis Medicinae

MARCH 01, 2000

[Music History Column; Versatility or Chaos?]

MALINA János

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HUN 2000;10(03)