Lege Artis Medicinae

[-Amicus Plato sed magis amica veritas-]


JULY 31, 1991

Lege Artis Medicinae - 1991;1(13)

[In each of the first 6 issues of Lege Artis we could read a thoughtful and forward-looking summary of the present and future problems of the Hungarian health care system, including the titles: Systemic change in health care, Reform change or system change, Where to go from here, health care, Can health care be transformed? The requirements of modern governance and management in health care, and SOTE: Questions and answers for reform. (1, 2, 3, 4, 5, 6,). If we agree that a correct analysis of the current situation and future of the medical profession and health workers is a sine qua non for any way forward, we must wonder why there is not a single mention (!) of the basic characteristic of these groups, their numbers. ]



Further articles in this publication

Lege Artis Medicinae

[Diagnosis and treatment of neck pain II. Treatment]


[The treatment of neck pain – such as the diagnostic procedure – requires the collaboration of the general practicioner and rheumatologic, neurologic; traumatologic and orthopedic experts. This part of the article interpretes methods and possibilities which can be made or prescribed by all the collegues for such patients. In case of acute neck pain bedrest, fixing instruments, peros medicamentation, local injections and physiotherapy are recommended. Patients suffering from chronic neck pain should be treated with active gymnastics, physiotherapic and relaxation methods rather than with oral therapy to avoid medical polypragmasy. Psychic running of these patients are emphasised. The authors conclude that general practicioners should play greater role in the treatment of neck pain, such as of arthrosis or backache.]

Lege Artis Medicinae

[Congenital haemorrhagic diathesis in childhood- an update]


[Following 164 haemophilic children in the Heim Pál Children's Hospital the authors call attention to the increased responsibility of paediatricians in diagnosis and long term care. They highlight haemarthroses leading to disableness, dental care, and the hazards of the treatment, such as changes in the immunstatus, transfer of infections, and the appearence of inhibitors. Hepatitis B profilaxis, introduced last year is mentioned as a favorable result. They call attention to the bad school results of the patients with average intelligence, the difficulties in the choice of profession and adaptation. They emphasize that the solution of the problems is an averall social duty. Finally, problems to be solved in the near future are listed. ]

Lege Artis Medicinae

[The clinical pathology of prostatic carcinoma]

KISS Ferenc

[On the basis of the actual state of art, the main tasks of clinical pathologists in the diagnostics of prostatic carcinoma may be summarized as follows: Recognition and differential diagnosis of prostatic adenocarcinoma. Estimation of tumour prognosis by means of a reliable histological grading system and establishing the pathological stage. Checking the efficacy of (hormonal) treatment relying upon histological features. An increasing effort to a better understanding and diagnosis of premalignant changes (dysplasia, prostatic intraepithelial neoplasia). In favour of individual characterization of a tumour, one should utilize the attainable modern investigative methods.]

Lege Artis Medicinae

[The role of the estracyt therapy in the treatment of prostatic cancer]

HATÁR András, LENGYEL István

[The authors – after summarizing the literature data – report the experiences of 57 prostatic cancer patients treated with Estracyt. The therapy was introduced as a primary one in 22 cases, and as a secondary treatment in 35 ones. It was administered mostly in T3-4 stadium cases with proved metastases. There was a complete regression in 8, partial regression in 15, while temporary regression in 14 cases (totally 64,9%). It is suggested, that the product can be used ensuring regression by the development of hormone resistance, by anaplastic tumors, and at the evolving of the recidiva following surgery or irradiation. A complete regression can be reached relatively rarely in advanced tumors. It can be used in either primary or secondary therapy. ]

Lege Artis Medicinae

[Diagnosis and therapy of prostate cancer]


[Prostate cancer is the third most common cancer in men. The majority of patients present to a doctor at an advanced stage with a tumour that has spread beyond the organ boundaries or with regional lymph node and haematogenous bone metastases. Correct treatment is based on correct clinical staging.]

All articles in the issue

Related contents

Clinical Neuroscience

The applications of transcranial Doppler in ischemic stroke


Background: This overview provides a summary of the applications of transcranial Doppler (TCD) in ischemic stroke. Results: A fast-track neurovascular ultrasound protocol has been developed for detecting occlusion or stenosis. The technique is more reliable in the carotid area than in the posterior circulation. By monitoring the pulsatility index the in­crea­sed intracranial pressure can be diagnosed. TIBI score was developed for grading residual flow. TCD has been shown to accurately predict complete or any recanalization. Regarding recanalization, TCD has a sensitivity of 92%, a specificity of 88%, a positive predictive value of 96%, a negative predictive value of 78% and an overall accuracy of 91%, respectively. Sonothrombolysis seemed to be a promising application but randomized controlled trials have shown that it does not improve clinical outcome. TCD examination can detect microembolic signals (MES) which are associated with an increased risk of stroke. Micro­em­boli were detected in symptomatic and asymptomatic carotid artery stenosis and during carotid endarterectomy. The number of microemboli can be decreased by antithrombotic therapy. Contrast en­chan­ced examination and Valsalva maneuver with continuous TCD monitoring can accurately screen for right-to-left shunt.

Clinical Neuroscience

[Psychometric properties of the Hungarian Adult Attachment Scale]

ŐRI Dorottya, KAPORNAI Krisztina, BAJI Ildikó, KISS Enikő

[The revised Adult Attachment Scale (AAS) developed by N. L. Collins is a widely used questionnaire to measure adult attachment. However, its psychometric properties have not been investigated in Hungary. We aimed to confirm the key psychometric properties of the Hungarian version of the AAS focusing on reliability indices on a population that consis­ted of depressed and non-depressed young adults. The AAS is a self-report questionnaire, in which two different dimensional evaluating systems are possible: the original (close, depend, and anxiety) and the alternative scoring system (anxiety, avoidance). Our study population consisted of young adults with a history of major depression (n = 264, median age = 25.7 years) and their never-depressed biological siblings (n = 244, median age = 24.0). The internal consistency of close, anxiety, and avoidance scales were satisfactory (Cronbach-α >0.7). The consistency of the depend scale was slightly lower than expected (Cronbach-α = 0.62). Test-retest reliability was good for all of the scales, it ranged from 0.73 to 0.78 after 14 months of follow-up period. The scale showed good discrimination as tested by the differences of close and anxiety attachment dimensions between the groups (p<0.01). More­over, we were able to differentiate the currently dep­res­sed subjects based on these attachment dimensions. Explo­ra­tory and confirmatory factor analyses were conducted, and a bifactor solution proved optimal model fit. The three dimensions of the AAS has not been confirmed. However, the close and anxiety scales of AAS were found to be adequate. Our results also indicate that attachment features correlate with major depressive episodes in adulthood.]

Lege Artis Medicinae

[Dilemmas of the holistic systems approach]


[Certainly one of the finest thinkers of the twentieth century, Martin Heidegger († 1976) accused Western thought since Plato of losing its sensitivity to ontological differences. It has become indifferent to being as the universal basis of existence. In 1950, in his Holzwege, Dead Ends, he sketches existence as a mysterious forest in which different systems of interpretation (logging roads-Holzwege) try to explore the fundamental questions of man and science from different angles. These paths, although approaching the problem from different angles, hold together, but in the end do not yield any relevant information about existence, about the whole. The universal basis is lost in their investigation. The paths are slowly overgrown with vegetation and the mystery of the forest remains unexplored. ]

Lege Artis Medicinae

[Laboratory control of the oral anticoagulant therapy]

VAJDA Zoltán, PÁL András, SIKOS Zita, SAS Géza

[There are two basic requirements in the treatment and prophylaxis of thromboembo lic diseases by chronic anticoagulation with coumarin (Syncumar). The first is the preven tion of a new thrombosis while the second is the avoidance of concomitant bleeding complications. For this reason it is necessary to achieve an appropriate anticoagulation level which can be characterised by labora tory measurement of the prothrombin level. In this paper, the theoretical and practical as pects of the laboratory control of Syncumar treatment are reviewed. The most serious problem is that the prothrombin level (Quick time) determinations utilising thromboplastin preparations from different sources give diffe rent values in the same patient plasma, which makes comparison of data from different laboratories impossible. The paper gives a brief overview of the definition and practical use of the International Sensitivity Index (ISI), characterising the different thromboplastin preparations, and the International Normali sed Ratio (INR) which can be calculated on the basis of the ISI. In spite of unquestionable improvements, the uncertainty about instrument-thromboplastin-ISI relationships reduces confidence in the INR system, especially when differences in INR values have clinical significance. Efforts need to be directed toward providing local, laboratory/instrument specific ISI values. ]

Hypertension and nephrology

[Antihypertenive effect of rilmenidine. Evaluation of the Hungarian multicenter VERITAS study]


[The VERITAS study showed that in hypertensive patients the imidazoline I1 receptor agonist, rilmenidine significantly decreased the office blood pressure as well as the blood pressure measured by ambulatory blood pressure monitoring (ABPM). The white-coat reaction and left ventricular hyperthrophy (LVH) were also decreased. Ain a separate study involving hypertensive subjects rilmenidine significantly increased baroreflex sensitivity. This effect may contribute - mainly during daytime - to the antihypertensive effect.]