Lege Artis Medicinae

[Dilemmas of the holistic systems approach]


JULY 29, 1992

Lege Artis Medicinae - 1992;2(07)

[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. ]



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Lege Artis Medicinae

[The role of prostacyclin in the function of the gastric mucosa]

BÁLINT Gábor Sándor

[The intracellular effect of exogenously admi nistered prostacyclin in the gastric mucosa seems to be a polyphasic one, namely: 1. effect on the cyclic nucleotide (CAMP, CGMP) turnover, 2. effect on the calmodulin-content, 3. DNA and RNA changes 4. influence on protein synthesis 5. new cell formation. Besides the endogenous prostacyclin exerts a natural protection against damaging noxae, thus maintaining the physiological integrity of the mucosa. ]

Lege Artis Medicinae

[What is the cause of delay in the diagnosis of the primary sjögren's syndrome?]


[Primary Sjögren's syndrome is the most frequent polysystemic autoimmune disease after rheumatoid arthritis. Keratoconjunctivitis sicca and xerostomia are characteristic of primary Sjögren's syndrome but the evolution of these signs may exist for years, and only one of them may be observed for a long time. Arthritis and enlargement of the parotid and submandibular glands are rarely observed as first symptom. The diagnosis of primary Sjögren's syndrome is based on the evaluation of the obligate signs. Clinical experience shows that there are many patients with undiagnosed Sjögren's disease. The authors would like to demonstrate the importance of the characteristic sings of primary Sjögren's syndrome, and the clinical and immunoserological tests which are useful in the diagnosis of the disease.]

Lege Artis Medicinae

[Clinical principles in the diagnosis and therapy of disseminated intravascular coagulation]

SAS Géza

[Psychologically intravascular coagulation of the blood is hampered by the endothelium, the inhibitors of the coagulation system and the circulation as well. Various pathological events may the diffuse activation of the blood coagulation factors causing disseminated intravascular coagulation. The two main consequences of the DIC are ischaemia in the organs concerned and the consumption of the blood coagulation factors. The activation of the fibrinolytic system improves the former though aggravates the latter pathological events. In the prevention and therapy the effective treatment of the basic disease is of primary importance. Thorough evaluation of the clinical symptoms and the laboratory data can help in the diagnostics. Heparin can be administered only in the hypercoagulative-consumptive forms of the DIC if bleeding does not exist actually. In recent years, the administration of the anti thrombin concentrate has come into prominence because it can promote the restitution of the coagulation system without increase of bleeding. Antifibrinolytic (Gordox) therapy is advised only in cases of extreme hyperfibrinolytic activity. ]

Lege Artis Medicinae

[Laboratory diagnosis of disseminated intravascular coagulation]

HORVÁTH Andrea Rita, MUSZBEK László

[Disseminated intravascular coagulation (DIC) is a highly dynamic process with a broad spectrum of clinical manifestations and laboratory findings. There is no specific laboratory test for the diagnosis of DIC. For the reliable diagnosis of DIC we recommend a test-panel which can be divided into three groups: 1, The screening tests include the measurement of prothrombin time, activated partial thromboplastin time, trombin time, platelet count and detection of fibrin monomers; 2, The diagnosis of DIC can be confirmed with the help of additional assays, such as the determination of fibrin degradation products, antithrombin III or the detection of fragmentocytes in peripheral blood smear; 3, Special tests such as determination of clotting factors, reptilase time, activation peptides and thrombin-antithrombin III complexes may serve as useful tools in the differential diagnosis and in the scientific evaluation of the mechanisms of DIC. In this paper the advantages and disadvantages of different laboratory tests used in the diagnosis of DIC are also critically evaluated. ]

Lege Artis Medicinae

[Tissue banking: possibility and challenge]


[The development of the tissue banking techniques has made possible the production of wide range of differently preserved collagen based tissue grafts (skin, bone, dura mater, fascia lata). Excellent clinical results have been obtained by the application of allogeneic and xenogeneic grafts. The article summarizes the activity fields of tissue banks in the USA and in Europe. The review presents the most important aspects of tissue banking, antigenicity, sterility, preservation and storage of different grafts. ]

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Lege Artis Medicinae

[Second game, 37th move and Fourth game 78th move]

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[What has Go to do with making clinical decisions? One of the greatest intellectual challenges of bedside medicine is making decisions under uncertainty. Besides the psychological traps of traditionally intuitive and heuristic medical decision making, lack of information, scarce resources and characteristics of doctor-patient relationship contribute equally to this uncertainty. Formal, mathematical model based analysis of decisions used widely in developing clinical guidelines and in health technology assessment provides a good tool in theoretical terms to avoid pitfalls of intuitive decision making. Nevertheless it can be hardly used in individual situations and most physicians dislike it as well. This method, however, has its own limitations, especially while tailoring individual decisions, under inclusion of potential lack of input data used for calculations, or its large imprecision, and the low capability of the current mathematical models to represent the full complexity and variability of processes in complex systems. Nevertheless, clinical decision support systems can be helpful in the individual decision making of physicians if they are well integrated in the health information systems, and do not break down the physicians’ autonomy of making decisions. Classical decision support systems are knowledge based and rely on system of rules and problem specific algorithms. They are utilized widely from health administration to image processing. The current information revolution created the so-called artificial intelligence by machine learning methods, i.e. machines can learn indeed. This new generation of artificial intelligence is not based on particular system of rules but on neuronal networks teaching themselves by huge databases and general learning algorithms. This type of artificial intelligence outperforms humans already in certain fields like chess, Go, or aerial combat. Its development is full of challenges and threats, while it presents a technological breakthrough, which cannot be stopped and will transform our world. Its development and application has already started also in the healthcare. Health professionals must participate in this development to steer it into the right direction. Lee Sedol, 18-times Go world champion retired three years after his historical defeat from AlphaGo artificial intelligence, be­cause “Even if I become the No. 1, there is an entity that cannot be defeated”. It is our great luck that we do not need to compete or defeat it, we must ensure instead that it would be safe and trustworthy, and in collaboration with humans this entity would make healthcare more effective and efficient. ]

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