Lege Artis Medicinae

[Faces from Parliament]

ANDRÁS László

MAY 27, 1992

Lege Artis Medicinae - 1992;2(05)

[In our previous issue Endre Pokony talked about his career and life, now we publish part II of his interview. ]

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Lege Artis Medicinae

[Treatment of endodermal thyroid cancers]

ÉSIK Olga, NÉMETH György

[Following staging procedures, differentiated thyroid cancers i. e. papillary and follicular carcinomas, are surgically treated with intra- or extracapsular total thyroidectomy (depending on the anatomical extent of the disease) and selective lymphnode dissection. Postoperative complementary use of adjuvant external and systemic radiotherapy is the general practice. External irradiation decreases local/regional relapses in all cases. Radioiodine treatment decreases local/regional/ distant recurrences in cases of tumour cells capable of iodine uptake. Life-long thyroxine medication is required, with a TSH-suppressive dose for relapse prevention and hormone substitution. This treatment regimen, a careful follow-up, and adequate rescue therapy are the prerequisites of the generally excellent patient prognosis, i. e. a survival probability measurable in decades. In anaplastic carcinoma following extracapsular total thyroidectomy and lymph node dissection, external irradiation is always indicated. Chemotherapy has a benefical effect on survival. Hormone replacement therapy is necessary to substitute for the missing metabolic effect of the thyroid. This combined modality treatment leads to some improvement with regard to the prognosis of this poor-risk type of cancer. ]

Lege Artis Medicinae

[Correspondence]

CSIZÉR Zoltán

["Programmed cell death" I read with great interest and attention Dr. Béla Szende's excellent communication on the biological and pathological significance of programmed cell death (apoptosis). Although the phenomenon of apoptosis (albeit under a different name) has been described for more than twenty years, its importance in the regulation of tissue homeostasis has only been recognized in the last few years. In 1991, for example, Jean Claude Ameisen and Andre Carpon of the Pasteur Institute in Lille put forward their hypothesis that apoptosis explains the qualitative and quantitative deficiency of helper T cells in HIV-infected patients.]

Lege Artis Medicinae

[Malnutrition syndrome in childhood part II.]

BAKSAI László, PHILIP W. H. Esker

[Malnutrition is a chronic nutritional disorder resulting from insufficient intake of caloric energy and/or some fundamental nutrients. Since it is the most common public health problem in the world it has a great impact on pediatric morbidity and mortality. The etiology is extremely complex. When one considers the less severe symptoms and signs caused by vitamin-, mineral-, and trace element deficiencies, it is apparent that not only children living in underprivileged countries are affected. In the course of making the diagnosis an assess ment of the nutritional status should also be made, especially considering the above-mentioned marginal nutritional deficiencies. The most common manifestation of nutritional disorders is anemia, which is mostly caused by lack of iron, vitamin B12, folic acid and can be complicated by infections. Nutritional requirements can be affected by several drugs. That is why this medication-nutrition interaction has to be kept in mind during treatment. The interaction of malnutrition and infection is very important, primarily for three reasons: mechanisms by which infection complicates the metabolic and nutritional status of the host; importance of suboptimal nutritional status on susceptibility and severity of intercurrent infections; clinical and therapeutic implication of these interactions. ]

Lege Artis Medicinae

[Operative Hysteroscopy]

BACSKÓ György

[Many thousands of hysterectomies are perfor med each year in women suffering from menorrhagia resistant to medical treatment but having, no demonstrable uterine abnormality. Hysteroscopy, the up to date diagnostic and therapeutic method can help to get advance in the diagnosis and therapy in these situations. In addition to permitting more precise diagnoses to be made, hysteroscopy allows the endometrium to be treated selectively under direct vision. The full thickness of the endometrium may be ablated using laser or resectoscope. The benefits of selective endometrial destruction versus hysterectomy are enormous. Patients undergoing endometrial ablation are frequently delighted with the short hospital stay, and the cost of this procedure is lower than the cost of hysterectomy. Many Müllerian fusion defects are amenable to hysteroscopic treatment. Patients with certain types of Müllerian defects undergoing hysteroscopic septotomy will enjoy as high a rate of reproductive success as those receiving more traditional procedures while avoiding the risks, the subsequent caesar sections, and the high cost. ]

Lege Artis Medicinae

[Transvaginal ultrasonography of embryo development in prematurity, sono-embryology I. The embryo and its appendages]

CSABAY László, SZABÓ István, NÉMETH János, PAPP Zoltán

[The authors performed serial examinations by a high resolution transvaginal transducer during the first trimester of pregnancy to show the most important stages of the early embryonal development. This is a preliminary study to a prospective, detailed screening programme in the first trimester of pregnancy. The earliest sign of pregnancy can be detected at the 29–31st days of menstrual age using vaginal transducer. During the 5th week the (secondary) yolk sac can be seen, which is an unambiguous evidence of an intrauterine pregnancy. The living embryo can be de monstrated on 36–38th days with the help of the pulsation of the embryonic heart tube. Certain embryonic structures appear in a defined order (developmental „calendar"). The physiologic midgutherniation can be observed during 7–11th weeks. Transvaginal sonography has gained popularity only recently due to technical advances. The main fields of use became gynaecology and early pregnancy, for there is no need to have a full bladder, for the lack of disturbing tissue layers. This method is essentially a combination of the bimanual gynaecological and the ultrasound examination. ]

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Lege Artis Medicinae

[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. ]