Lege Artis Medicinae

[Faces from Parliament]

FEBRUARY 26, 1992

Lege Artis Medicinae - 1992;2(02)

[Csaba Fáklya, SZDSZ; I was born in Budapest, the eldest son of a family with six children. Coincidentally, like so many politicians today, I graduated from Toldi High School. There were many illnesses in the family, my father was a severe lung patient and later died of cancer. It is possible that this is why I was attracted to the medical profession. ]

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Lege Artis Medicinae

[New methods of plastic surgery for breast reconstruction]

GULYÁS László

[The treatment and plastic surgical reconstruction of breast tumour patients raise contradictions and unsolved problems. The approach of breast tumour surgery has been changed recently. New evidence shows that in terms of survival, free from distant disease there is no significant difference between lumpectomy and radical mastectomy. Thus breast-conserving operations as a replacement for radical mastectomy have been spreading. The most characteristic features of these operation are: the horizontal incision, the conservation of the pectoral muscles and the whole or partial preservation of glandular tissues. The quality and quantity of available tissues for the breast reconstruction have changed as, the methods of plastic surgical operations has been adopted. New methods for breast reconstruction such as muscle and musculocutaneous flaps, free flaps, different breast implants, and skin expanders have become more and more preferred. For nipple and areola reconstruction local flaps, skin grafts, external prostheses and tattoo are widely used. Nowadays the most important point of view in there the construction of the breast are accurate symmetry, aesthetic breast form and harmony of the whole body. ]

Lege Artis Medicinae

[Results in the sclerotherapy of varicocele]

POKORNYI Lajos, BALI Ilona, NAGY Endre, VADON Gábor, SZÖLLŐSI János

[Testicular varicocele which is curable by surgical or transcatheteric methods is one of the most common causes of male infertility. In this study the success of the interventional radiological method was evaluated. Internal spermatic vein phlebographies were performed in the case of left sided varicocele. Before intervention the anamnesis, inspection, palpation, sonography, colour Doppler sonography and phlebography was evaluated and in a part of the cases spermiogramm too. Follow up examinations were performed at 3, 6 and 12 months after the sclerotherapy and the 1.5-4.5 years then later. The internal spermatic vein was succesfully occluded in 2/3 of the patients in the distal third, in 1/3 in the middle or in the upper third. Complications occurred in 10 cases as intima lesions without any consequencies and in 4 patients as scrotal thromboph lebitis. At the follow up examinations very good regression was demonstrated. Persistence or recurrence occured in 5.7% of cases. The spermiogramm usually got back to normal or showed an improvement and we registered 8 pregnancies from 23 formerly infertile marriages. The interventional radiological method is simpler, cheaper, requires shorter time and inpatient period, decreases sick-allowance, and the success rate reaches the level of the surgical method. The joint evaluation of the real time and the colour Doppler ultrasound is a very sensitive method in the interpretation of the results of the treatment. In our opinion sclerotherapy with Varicocid is the method of choice in the treatment of the varicocele. ]

Lege Artis Medicinae

[Mapping of EEG in neurological disorders]

SZIRMAI Imre, JUHÁSZ Csaba, SUREK György, DOLOGH Ervin

[Mapping is a new way to convey the information of the mathematical analysis of the EEG in an immediately understandable form. In this article, the history of EEG mapping is surveyed. Sixteen channel EEG mapping system was programmed on an IBM-AT personal computer which constructs absolute and relative power spectra topograms on the scalp. Hemispheric asymmetry and long term changes of absolute and relative power estimates were calculated by statistical methods (Wilcoxon and Student t-test). In comparison traditional reading of the EEG the mapping has the following advantages: 1. it uses exact procedures instead of qualitative estimation; 2. in can detect minimal cortical damages; 3. it has the ability to store data for later comparison: the power ratios in selected frequency ranges proved to be a reliable indicator of post-ischemic restitution of EEG; 4. it can evaluate of event related reactions of bioelectric signals in higher resolution. EEG topography provides early information regarding the severity of ischemic lesions in the acute stage of stroke before to the CT scan can visualize the tissue hypodensity. In cases of permanent epileptic waves, the mapping visualizes the local power maxima of dominant frequency ranges and detects the post-ic talimpairment of cortical fields of epileptic foci. Probability significance mapping has reinstated the diagnostic value of EEG by the applica tion of the neuroimaging techniques.]

Lege Artis Medicinae

[Bidirectional Doppler investigation of the internal carotid artery]

FARKAS Katalin, HORVÁTH Péter, KUSZTOS Dénes

[The blood-flow velocity in carodit arteries was measured with a bidirectional CW Kranz bühler 761 Doppler instrument. These investigations were supplemented with special compression tests. 60 investigations were performed to study the blood-flow in the supraorbital and supra trochlear arteries, while compressing the superficial temporal, the facial and the common carotid arteries. The results were compared with 30 regularly performed angiographies. Conclusions: the sensivity of this method is 80%, the specificity is 85%, its positive and negative predictive values are 76% and 87% respectively. Therefore this method is suggested for screening the internal carotid artery. ]

Lege Artis Medicinae

[Ultrasound examination of the knee]

CSÓKÁSI Zsolt, MORVAY Zita, VADON Gábor

[The knee is frequently injured. In addition to the phisical examination imaging methods are very important in determining the diagnosis of the disorders. Ultrasound method is useful in revealing the injuries of the soft tissues of the knee. The authors examined 350 patients with an Acuson 128 ultrasound machine, using 5 and 7 MHz linear transducer in standard positions. They analized the pathological disorders of the knee joint. They consider the examination of network of the band important. Sonography has a significant role in the diagnosis of knee disorders. That can replace more expensive or invasive examination methods.]

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[Familiar faces - the portraits of Habsburg sovereigns]

NÉMETH István

Lege Artis Medicinae

[About the same thing elsewhere, in a different tone]

ANDRÁS László

[It was a gesture of thanks and appreciation that a few days after the publication of the 1992/6 regulation on general practitioners, senior staff from the Ministry of Public Welfare and the OTF presented and discussed it with their colleagues at the LAM Club. Naturally, this was done only after the regulation had been published. They did not receive the same recognition and thanks when they made the same gesture to their colleagues sitting as Members of Parliament in the Committee on Social Affairs and Health. ]

Lege Artis Medicinae

[Treatment of clubfoot with the Ponseti method]

KISS Sándor, TEREBESSY Tamás, HORVÁTH Nikoletta, DOMOS Gyula, GRESITS Orsolya, SZŐKE György

[INTRODUCTION - Congenital clubfoot is a severe developmental disorder. Without treatment, only the lateral border of the foot can be loaded and the sole faces the contralateral side. Good results can usually be achieved with early redression by serial casting (generally from the first week after birth) followed by extensive surgery at age six months (Achilles tendon lengthening, capsulotomy of the talo-crural and subtalar joints). The above procedure has been revolutionised by the method described by Ignacio Ponseti based on his own experiences, which has modified the casting technique and has also radically changed the surgical intervention. In this paper we report our experiences with Ponseti’s method and draw attention to this less invasive procedure. PATIENTS AND METHODS -The essence of Ponseti’s techniqe is reposition of the talonavicular joint, for which the foot is corrected in a different way compared with previous practice. Following redression for 8-10 weeks, percutaneous complete Achilles tenotomy is performed and the foot is fixed for further three weeks. A special orthesis is worn in the following 6 months for 24 hours a day and the same ortézis is suggested for overnights afterwards. In our institution, 171 clubfeet (45 unilateral, 126 bilateral; 84 right, 87 left; 25 girls, 83 boys) were treated between 2007 and 2012. Our results were evaluated with the help of the Pirani score, which is a widely used method for assessment of clubfoot treatment. RESULTS - Results were evaluated at the beginning of the treatment, at the end of redression and after percutaneous Achilles tenotomy. Pirani scores were 4.54±1.30; 1.48±1.02 and 0.59±0.45 respectively. The average dorsal flexion of the ankle joints was 23±12 degrees. CONCLUSION - Our own observations support the good results published in the literature, therefore the less invasive Ponseti method is suggested for the primary treatment of congenital clubfoot.]

Lege Artis Medicinae

[More pains of labour]

ANDRÁS László

[No luck for the Hungarian Medical Chamber's Bureau draft law to discuss the draft law with MPs. About six months ago, the Social Affairs Committee wanted to put the draft on its agenda for debate, but was thwarted by the question of form, which was only apparently a question of form, but in fact of substance: if it is a draft law, who submitted it to the parliamentary committee. A professional body is not entitled to do that. On this basis, the Members did not wish to discuss it at the time - at least now, and let us be precise here! - the draft chamber bill. Since then, the Presidency of the Chamber has revised the drafting in a public debate, has thoroughly liberalised it and would have liked to present it to the Members of Parliament who are doctors, and discuss it, now wisely calling it a working document. Such a meeting is not a statutory forum, has no agenda, and is not intended to be a lobbying exercise in the good sense.]

Lege Artis Medicinae

[The Social Security Health Insurance Fund's Mental Hygiene Board of Trustees]

[The Board of Trustees of the Social Insurance Health Insurance Fund for Mental Hygiene invites applications for the implementation of mental health promotion and mental hygiene programmes from the fund allocated by Parliament from the 1993 social insurance budget, pursuant to Act LXXXIV of 1992. ]