Lege Artis Medicinae

[Deployment in Carthage December 1943]

J G Scadding1

APRIL 27, 1994

Lege Artis Medicinae - 1994;4(04)

[I served in the Royal Army Medical Corps for most of the Second World War. In January 1939, I became Chief Medical Officer at Brompton Hospital, but remained on the staff of the British (now Royal) Postgraduate Medical School (Hammersmith), which I joined when it started in 1935.]


  1. Emeritus professor of medicine, Beaconsfield Buckinghamshire



Further articles in this publication

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. ]

Lege Artis Medicinae

[The clinical significance of amaurosis fugax]


[The symptoms of amaurosis fugax (transient monocular loss of vision) indicate not only atherosclerotic disease of the ocular or extra cranial cerebral vessels, but also that of the systemic circulation. The prognostic significance of amaurosis fugax developing after the age of 50-55 years is similar to that of transient ischaemic attack of the brain: it could be a harbinger of atherosclerotic disease of the extra- and intracranial brain vessels as well as the coronary arteries. According to the mortality data, patients presenting with symptoms suggestive of amaurosis fugax will die due to heart disease, primarily myocardial infarct. Diagnostic evaluation should include not only ophthalmological, but also neurological and cardiovascular in vestigation to verify carotid and coronary atherosclerosis. Therapy of the whole disease and not just the symptoms will influence life expectancy in patients with amaurosis fugax. ]

Lege Artis Medicinae

[Methylprednisolone pulse therapy in systemic lupus erythematosus]


[The aim of this retrospective study was to assess the efficacy and safety of methylprednisolone pulse therapy. Thirty five patients with severe systemic lupus erythematosus (lupus nephritis, severe hemolysis and antiphospholipid syndrome with central nervous system involvement, arterial occlusion and thombocytopenia) were treated by pulse methylprednisolone, followed by long-term corticosteroid (and cyclophosphamide) therapy. Thirty four patients achieved remission, after a mean of 4.7 weeks, which lasted on average for > 2.7 years. Six patients presented with an exacerbation after 1-2.5 years. Twenty eight patients are still in remission. No side effects were observed during pulse therapy. Methylprednisolone bolus therapy is safe and effective in severe systemic lupus erythematosus, including cases of lupus nephritis and severe central nervous system manifestations, but an appropriate choice of long-term therapy is essential.]

Lege Artis Medicinae

[The value of immunoscintigraphy in patients with metastatic malignant melanoma]

PAPÓS Miklós, LÁNG Jenő, CSERNAY László, SZEKERES Lenke, KUBA Attila

[Immunoscintigraphy with 99MTc-labeled F(ab'),fragments of monoclonal antibody (reactive with a high molecular associated antigen) was performed in patients with malignant melanoma. 24 investigations on 23 patients were carried out. A total of 40 lesions in 23 patients were detected by chest radiography, ultrasound, CT, bone scintigraphy or histology. 24 of the 40 lesions (60%) were visualized by immunoscintigraphy. Following correction of the physiological liver background by digital subtraction, 3 liver metastases were localized. These results indicate that immunoscintigraphy with radiolabeled F(ab')2 fragments can provide clinically useful information. ]

Lege Artis Medicinae

[Methodological letter from the Public Health and Epidemiology Technical College on vegetarian and similar diets in crèches and educational establishments]

[The nutritional status of vegetarians is strongly influenced by the type of diet they eat. While semi-vegetarian and lacto-ovo-vegetarian diets can meet the nutrient needs of young children, provided they are carefully and professionally planned, strict vegetarian or macrobiotic diets may not meet the needs for some nutrients and may be deficient in both children and adults. ]

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Journal of Nursing Theory and Practice

[Identifying osteoporosis in a primary care setting with quantitative ultrasound]

HIRDI Henriett Éva, SZOBOTA Lívia

[Osteoporosis is one of the most under-diagnosed and under-treated health conditions. In recent decades, several risk indices have been developed to identify women at risk for low bone mineral density (BMD) who require a BMD test. This study aimed to demonstrate that quantitative ultrasound bone density measurement can indeed be performed simply by nurses working in primary care, which can significantly facilitate early detection of osteopenic and osteoporotic conditions. Method: The medical records of all patients who had an ultrasound of the left heel using the quantitative heel ultrasound machine between March 2021 through December 2021 were reviewed retrospectively. The subjects were 20-64-year-old adults (N=1032). Calcaneal quantitative ultra­sound parameters were registered with Sonost-2000 bone densitometer. The body composition was measured using a multi-frequency segmental body composition analyzer. The measurement results were evaluated with SPSS 22.0 statistical program and descriptive statistics. The mean age of the population studied was 43.12±9.6 years; 29.7% were men and 70.3% were women. Of the women in our study, 2.4% were osteoporotic (T ≤ −2.5), and 49.86% were classified as osteopenic according to the WHO operational definition. Osteopenic values were measured in 32.35% of men. A total of 273 subjects (26.45%) in the study sample were in the 50-64 age group (223 women and 50 men). 4% of women over the age of 50 had osteoporosis and 63.7% had osteopenia. Rating of the OST score no one was placed in the high-risk group. Of the 9 women with osteoporosis, 8 were classified as low-risk and 1 as medium based on OST. Nurses in primary care are able to identify key risk factors for osteoporosis, examine the measurement with quantitative ultrasound, and identify individuals with the disease. ]

Clinical Neuroscience

[Rehabilitation possibilities and results after neurosurgical intervention of brain tumors ]

DÉNES Zoltán, TARJÁNYI Szilvia, NAGY Helga

[Objectives - Authors examined the rehabilitation possi­bi­lities, necessities, and results of patients after operation with brain tumor, and report their experiences. Method - Retrospective, descriptive study at the Brain Injury Rehabilitation Unit, in National Institute for Medical Rehabilitation. Patients - Patients were admitted consecutively after rehabilitation consultation, from different hospitals, following surgical intervention of brain tumors, between 01 January 2001 and 31 December 2016. Patients participated in a postacute inpatient rehabilitation program, in multidisciplinary team-work, leaded by Physical and Rehabilitation Medicine specialist included the following activities: rehabilitation nursing, physical, occupational, speech, psychological and neuropsychological therapy. Results - At the rehabilitation unit, in the sixteen-year period 84 patients were treated after operation with brain tumor. Patients arrived at the unit after an average of 41 days to the time of the surgical intervention (range: 10-139 days), and the mean length of rehabilitation stay was 49 days (range: 2-193 days). The mean age of patients was 58 years (20-91), who were 34 men and 50 women. The main symptoms were hemiparesis (64), cognitive problems (26), dysphagia (23), aphasia (16), ataxia (15), tetraparesis (5), and paraparesis (1). The mean Barthel Index at the time of admission was 35 points, whereas this value was 75 points at discharge. After the inpatient rehabilitation, 73 patients improved functionally, the status of 9 patients did not show clinically relevant changes, and 2 patients deteriorated. During the rehabilitation 10 patients required urgent interhospital transfer to brain surgery units, 9 patients continued their oncological treatment, two patients continued rehabilitation treatment at another rehabilitation unit, and after rehabilitation 73 patients were discharged to their homes. Conclusions - Inpatient rehabilitation treatment could be necessary after operation of patients with brain tumor especially when functional disorders (disability) are present. Consultation is obligatory among the neurosurgeon, rehabilitation physician and the patient to set realistic rehabilitation goals and determine place and method of rehabilitation treatment, but even at malignancies cooperation with oncological specialist also needed. Authors’ experience shows benefits of multidisciplinary rehabilitation for patients after brain tumor surgery. ]

Clinical Neuroscience

[Dopamine agonists in Parkinson’s disease therapy - 15 years of experience of the Neurological Clinics from Tîrgu Mureș. A cross-sectional study ]

SZÁSZ József Attila, CONSTANTIN Viorelia, MIHÁLY István, BIRÓ István, PÉTER Csongor, ORBÁN-KIS Károly, SZATMÁRI Szabolcs

[Background and purpose - There is relatively few data regarding the usage of dopaminagonists for the treatment of Parkinson’s disease; furthermore, there are no publications regarding Central- and Eastern-European countries. The aim of the study was to evaluate the use of dopamine agonists as a therapeutic option amongst Parkinson’s disease patients admitted to the Neurological Clinics of Tîrgu Mures during the last 15 years. Methods - In our study we investigated the data of all Parkinson’s patients treated at our clinics between the 1st of January 2003 and the 31st of December 2017. We analyzed the particularities of dopamine agonists’ usage based on the therapeutic recommendations from the final report of these patients. Regarding time since the diagnosis, we divided the patients in two groups: less than or equal to 5 years and more than 5 years. Results - During the studied period a total of 2379 patients with Parkinson’s disease were treated at the Clinics. From the 1237 patients with disease duration under 5 years 665 received dopamine agonists: 120 as monotherapy, 83 together with monoamine oxidase inhibitors and in 234 cases associated with levodopa. The remaining 228 patients were treated with a triple combination of levodopa, dopamine agonists and monoamine oxidase inhibitors. In patients suffering from Parkinson’s disease for more than 5 years, in 364 cases out of 653 a dopamine agonist was part of the therapy. Conclusion - The usage of dopamine agonists was similar to the data presented in other studies. We consider that clinicians treating the disease should, with the necessary prudence, use the available and recommended dopamine agonist with the utmost courage to their maximum therapeutic potential.]

Clinical Neuroscience

Retrospective comparison of efficacy of levetiracetam and lacosamide add-on treatments in patients with partial onset seizure

ACAR Türkan, ARAS Guzey Yesim

Objective - The study aims to retrospectively compare the efficacy of lacosamide (LCS) and levetiracetam (LEV) in add-on treatment in patients with partial-onset epilepsy. Material and method - Patients who have been followed-up for at least one year due to diagnosis of partial epilepsy between September 2014 and December 2017 and who had no seizure control, despite using at least two antiepileptic monotherapies, and therefore undergone LEV or LCS add-on treatment were retrospectively reviewed. Of the patients, total number of seizures and seizure control rates 6 months before and 3 and 6 months after the add-on treatment were compared. Results - There was no statistically significant difference between the 30 patients in the LEV group (12 females, 18 males, mean age 29.7±6.6) and 28 patients in the LCS group (12 females, 16 males, mean age 28.2±6.4) in terms of age, gender and the duration of illness. When the LEV and LCS groups were evaluated separately, the mean number of seizures within 3 and 6 months after the add- on treatment were significantly lower than the mean number of seizures in the last 6 months before the add-on treatment (p<0.005 and p<0.005 respectively). There was no statistically significant difference between the two groups when compared with each other in terms of the rate of decrease in number of seizures and seizure control before and after the add-on treatment (p=0.445 and p=0.238, respectively). Conclusion - LCS appears to be as effective as the currently well-established LEV in the treatment of partial onset seizures. No comparative study was found in the literature similar to this subject matter. There is a need for prospective studies for the comparison of the efficacies of these two drugs.

Hypertension and nephrology

[Data on blood pressure over two years in resistant hypertensive patients with lett brain stem microvascular decompression]


[In the background of resistant hypertension (RHT) the neurovascular pulsatile compression (NVPC) of the left rostral ventrolateral medulla may play a role. In these cases a microvascular decompression (MVD) may decrease the blood pressure (BP). The aim of this work was to investigate how the BP has changed after the MVD in the operated patients recorded at the farthest time from the MVD up to maximum 31 December 2016. We have retrospectively collected data from 9 patients whose follow-up data fór 2 years has already been published earlier. Data collection was carried out from the patient register program of the University of Szeged Albert-Szent Györgyi Clinical Centre. The MVDs were performed between 2000 and 2004. The mean follow-up time was 11.1±4.6 years. Both the systolic and the diastolic BPs were significantly lower at the time of last record compared to the BPs at the time of MVD (systolic BP 211±40 vs. 135±20 mmHg, p=0.003; diastolic BP 116±17 vs. 81±14 mmHg, p=0.007). Last recorded BPs compared to the 24-month data alsó were lower bút nőt signffi- cantly (systolic BP 148±32 vs. 135±20 mmHg, p=0.25; diastolic BP 96 vs. 85 mmHg, p=0.11). The mean number of antihypertensives at the last Office visít was nőt sig- nificantly higher compared to MVD (5.9±1.4 vs. 6.3±1.5; p=0.5) bút signfficantly increased compared to MVD +1 month data (4.7±0.9vs. 6.3±1.5; p=0.03). These results confirmed our previous opinion that in severe RHT nőt respond- ing to conventional therapy an MVD of the left side NVPC could be a therapeutic option and may guarantee a long-lasting BP reduction. Evén if the number of antihypertensives increased in the meantime, as they still responded better to therapy. ]