Lege Artis Medicinae

[Entrepreneurial healthcare - an insured society]

JANUARY 29, 1992

Lege Artis Medicinae - 1992;2(01)

[The Ministry of Public Welfare and the Hungarian Public Relation Association have started to organise a three-day international congress under the above title. We asked Tamás Barát, Secretary General of the Hungarian Public Relations Association, about the aims of the congress. ]

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Lege Artis Medicinae

[Biological and Pathological Significance of Apoptosis (Programmed Cell Death)]

SZENDE Béla

[Programmed cell death (apoptosis) basically differs from necrosis regarding its biological significance, the morphological signs and biochemical events. Apoptosis is the result of an active cell function, so-called cell-suicide and it is observable in several biological as well as pathological processes. Enhancement of apoptosis can be achieved in malignant tumors by hormonal treatment. This explains the mode of action of hormones in tumor therapy and also contributes to the alterations in gene regulation leading to apoptosis.]

Lege Artis Medicinae

[The use of BCG immunotherapeutic for the treatment of superficial bladder cancer (carcinoma in situ and papillary tumor)]

CSIZÉR Zoltán

[BCG Immunotherapeutic (BCG IT) is the first immunomodulator to be licenced in Canada, Germany and the United States for the use in the treatment of carcinoma of the urinary bladder. The product licence was granted following the conduct of a well designed efficacy study. The study was multicente red, independent and controlled with well defined end points and a long follow up period. The results clearly shows that BCG immunotherapy is significantly more effective than Adriamycin chemotherapy. There is no evidence to suggest a difference in severity of toxicities between BCG and Adriamycin treatment groups.]

Lege Artis Medicinae

[Transesophageal and transthoracic echocardiography in aortic dissection]

LENGYEL Mária

[ The severe prognosis of aortic dissection can only be improved by early diagnosis. The role of echocardiography was assessed. Echocardiographic findings were analysed in 32 patients in whom aortic dissection was confirmed by other methods between September 1984 and July 1991. In 19 of them only transthoracic echo (TTE), in 13 patients both TTE and transesophageal echo (TEE) was performed. Control group consisted of 21 patients in whom the clinical suspicion of dissection was ruled out. The DeBakey classification was used. Among 14 acute and 18 chronic cases type I was confirmed in 9, type II in 15 and type III in 8. The sensitivity of clinical suspicion, TTE, TEE and angiography was 34, 72, 92, 94% resp. TEE correctly identified the types, entry and reentry sites, false lumen and left coronary ostium. TTE was valuable in the detection of complications and of etiologic factors of dissection. Hypertension (12) and Marfan's syndrome (7) were the leading etiologic factors. As previously has been reported in the diagnosis of aortic dissection TEE was a safe and reliable technique. It was superior to TTE and was as correct as angiography. The combined use of TTE and TEE is recommended in each case of clinically suspected dissection. The importance of the echocardiographic detection of cardiac complications and etiologic factors is emphasized in the management and prevention.]

Lege Artis Medicinae

[Oral symptoms in the early diagnosis of leukaemias]

GYURKOVICS Csilla, BÁNÓCZY Jolán

[Diseases of the haemopoetic system are often preceeded and/or accompanied by clinical changes in the oral cavity, which, as first signs of the disease, might be of important diagnostic value. Primary oral findings are characteristic mainly of acute leukaemias, such as haemorrhagies, petechias, ecchymoses, ulcera, gingival hy pertrophy, painful gingiva, tooth mobility, candidiasis, herpes simplex infection, lymph node enlargements. Oral manifestations of chronic leukaemia may also arouse the suspicion of a haemopoetic disease. Applied cytostatic therapy might aggravate the condition of oral manifestations. ]

Lege Artis Medicinae

[Peritoneal dyalisis in hungary]

KARÁTSON András, MAKÓ János

[Traditional intermittent peritoneal dialysis in patients with chronic uremia lasts for 8 to 10 hours three times a week. In 1976 Popovich et al. outlined the principle of CAPD (Continu ous Ambulatory Peritoneal Dialysis), a technique giving good results in the removal of water and toxic substances. The procedure is used in 19 000 patients in US and in 9600 patients in Europe. In early 1991 the technical conditions and the number of patients receiving peritoneal dialysis were surveyed in the Hungarian nephrological and dialysing units. Not only the number of patients with chronic uraemia (those undergoing dialysis + transplantation) is lower in this country as compared to the European average (106 versus, 236 per million people, respectively) but the distribution of patients according to the type of treatment they receive is also different. In Hungary intermittent peritoneal dialysis has been used in more than 10% of the cases for several years whereas the number of those receiving continuous peritoneal dialysis has been under 2%. (In Europe < 2% and 4–43%, respectively). The survey also included the types of solution, desinfection and connecting devices used in peritoneal dialysis, as well as the incidence of peritonitis and the administration of antibiotics . The principles of biocompatibility, the function of interleukin as well as the effectiveness and the conditions of home treatment are summarized. ]

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

VOKÓ Zoltán

[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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Cholinesterase inhibitors and memantine for the treatment of Alzheimer and non-Alzheimer dementias

BALÁZS Nóra , BERECZKI Dániel, KOVÁCS Tibor

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