Lege Artis Medicinae

[Gastroenterology in general practice]

ÚJSZÁSZY László

MAY 26, 1993

Lege Artis Medicinae - 1993;3(05)

[Report on the training course organised in Hatvan on 19-20 March 1993 by the Hungarian Gastroenterological Society, the Hungarian College of Gastroenterology and the Education Committee of the Hungarian Medical Chamber with the support of MEDICOM-Glaxo.]

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Lege Artis Medicinae

[The prerequisite of T cell recognition: antigen processing and presentation]

RAJNAVÖLGYI Éva

[Multiple regulatory mechnanisms are activated wit hin the immune system to maintain the homeostasis of the organism. A key element of these processes is the specific recognition of antigens mediated by T and B lymphocytes. This is the basis of clonal selection and antigen specific activation of the immune system (LAM 1991. 1(18):1308–1314.) which results in the most efficient elimination of the antigen. T cells play a predominant role in the discrimination of self and non-self structures. Antigen specific activation of T cells results in the expression of cell surface molecules and in the production of different lymphokines of high biological activity, which define the possibilities for cell to cell interactions and influence the function of different cell types affecting the outcome of the immune response. The appropriate activity of functionally distinct T cells enables the most efficient mobilization of effector mechanisms leading to the elimination of the antigen without destroying self components. In order to exert their regulatory and effector functions they require a well regulated collaboration with antigen presenting cells. This review summarizes our present knowledge on the intracellular degradation and transportation pathways occuring on in antigen presenting cells determining the antigen specific functions of T cells. It is well established that these events influence the efficacy or protection against pathogens and have a basic influence on the normal or pathological outcome of autoimmunity.]

Lege Artis Medicinae

[Thoughts on radical hysterectomy]

BŐSZE Péter

[Radical hysterectomy and pelvic lymphade nectomy have been used for the treatment of carcinoma of the uterine cervix in most Western countries for decades. These surgical procedures, however, have rarely been advocated in Hungary. Advantages and disadvantages of radical hysterectomy with pelvic and paraaortic lymph node dissection are discussed. Emphasis is placed on patient selection. It is the author's view that radical surgery does have a place in the management of cervical cancer. The patient should be informed about the possible treatment modalities available such as radical surgery, radical radiation therapy or a combination of surgery and irradiation, and she should be involved in the decision making process. Radical hysterectomy with pelvic lympha denectomy is a major operation with potentially significant intraoperative and postoperative complications. A dequate surgical skill and sufficient experience are required and this procedure should be regularly practiced. For these reasons, it is probably best performed in cancer centres.]

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. ]

Lege Artis Medicinae

[The role of computed tomography in tumor staging of bronchogenic carcinoma]

HEILER Zoltán, PÁLFFY Gyula, KOSTIC Szilárd, MONOSTORI Zsuzsanna, REPA Imre

[Operability of lung cancer is based on the size and local extension of the tumor as well as the presence of lymph node and distant metastases. Agreement and disagreement between CT and surgical tumor staging was investigated for 197 cancer patients after surgery. Sensitivity and specificity of CT prediction ranged 57–93% and 71–100% ac cording to tumor stadium. CT diagnosis has been relatively unreliable in describing tumor propagation along the pulmonary veins (less frequently arteries) towards the atrium and in recognizing a discrete tumor invasion of the mediastinum. Local thickening of the parietal pericardium, and small pericardial effusion have been considered as indirect signs of pericardial tumor infiltration. MR examination have been found to be a supplemental technique for assessing tumor spread to the great vessels of the mediastinum. The authors believe on the results that new techniques, such as MR angiography and indirect CT signs will help in making a more accurate preoperative diagnosis of lung cancer.]

Lege Artis Medicinae

[Report on gastroenterological endoscopic activity in Hungary in 1992]

NAGY György, JUHÁSZ László

[At the request and on behalf of the Endoscopic Section of the Hungarian Gastroenterological Society, we have compiled the main data of the Hungarian endoscopic activity in 1992. We received responses to our questionnaire from 117 endoscopic laboratories and one private endoscopic practice. The responses received were summarised in a table.]

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Comparison of direct costs of percutaneous full-endoscopic interlaminar lumbar discectomy and microdiscectomy: Results from Turkey

ÜNSAL Ünlü Ülkün, ŞENTÜRK Salim

Microdiscectomy (MD) is a stan­dard technique for the surgical treatment of lumbar disc herniation (LDH). Uniportal percutaneous full-endoscopic in­terlaminar lumbar discectomy (PELD) is another surgical op­tion that has become popular owing to reports of shorter hos­pitalization and earlier functional recovery. There are very few articles analyzing the total costs of these two techniques. The purpose of this study was to compare total hospital costs among microdiscectomy (MD) and uniportal percutaneous full-endoscopic interlaminar lumbar discectomy (PELD). Forty patients aged between 22-70 years who underwent PELD or MD with different anesthesia techniques were divided into four groups: (i) PELD-local anesthesia (PELD-Local) (n=10), (ii) PELD-general anesthesia (PELD-General) (n=10), (iii) MD-spinal anesthesia (MD-Spinal) (n=10), (iv) MD-general anesthesia (MD-General) (n=10). Health care costs were defined as the sum of direct costs. Data were then analyzed based on anesthetic modality to produce a direct cost evaluation. Direct costs were compared statistically between MD and PELD groups. The sum of total costs was $1,249.50 in the PELD-Local group, $1,741.50 in the PELD-General group, $2,015.60 in the MD-Spinal group, and $2,348.70 in the MD-General group. The sum of total costs was higher in the MD-Spinal and MD-General groups than in the PELD-Local and PELD-General groups. The costs of surgical operation, surgical equipment, anesthesia (anesthetist’s costs), hospital stay, anesthetic drugs and materials, laboratory wor­kup, nur­sing care, and postoperative me­dication diffe­red significantly among the two main groups (PELD-MD) (p<0.01). This study demonstrated that PELD is less costly than MD.

Lege Artis Medicinae

[Diagnosis and treatment of microvascular coronary heart disease. Specialities of conditions in Hungary]

SZAUDER Ipoly

[Invasive investigations show that in two-thirds of patients the myocardial ischaemia persists without obstructive coronary disease and any other heart conditions (INOCA). The underlying cause may be microvascular dysfunction (CMD) with consecutive microvascular coronary disease (MVD) and microvascular or epicardial vasospastic angina (MVA). The modern practice of clinical cardiology while using the developed non-invasive cardiac imaging permits exact measuring of the coronary flow with its characteristic indices. All of these improve the diagnosing of CMD-induced myocardial ischemia and provide opportunity to determine primary MVD cases. Since the recognition and treatment of MVD is significantly underrep­resented in the Hungarian medical care, the primary stable microvascular angina (MVA) is described in detail below with its modern invasive and non-invasive differential diagnosis and treatment, concerning especially its frequency provoked by high blood pressure and female coronary heart diseases. There are highlighted all recommended diagnostic procedures available under domestic conditions.]

Lege Artis Medicinae

[Focus on Lege Artis Medicinae (LAM)]

VASAS Lívia, GEGES József

[Three decades ago, LAM was launched with the goal of providing scientific information about medicine and its frontiers. From the very beginning, LAM has also concerned a special subject area while connecting medicine with the world of art. In the palette of medical articles, it remained a special feature to this day. The analysis of the history of LAM to date was performed using internationally accepted publication guidelines and scientific databases as a pledge of objectivity. We examined the practice of LAM if it meets the main criteria, the professional expectations of our days, when publishing contents of the traditional printed edition and its electronic version. We explored the visibility of articles in the largest bibliographic and scientific metric databases, and reviewed the LAM's place among the Hun­ga­rian professional journals. Our results show that in recent years LAM has gained international reputation des­pite publishing in Hungarian spoken by a few people. This is due to articles with foreign co-authors as well as references to LAM in articles written exclusively by foreign researchers. The journal is of course full readable in the Hungarian bibliographic databases, and its popularity is among the leading ones. The great virtue of the journal is the wide spectrum of the authors' affiliation, with which they cover almost completely the Hungarian health care institutional sys­tem. The special feature of its columns is enhanced by the publication of writings on art, which may increase Hungarian and foreign interest like that of medical articles.]

Lege Artis Medicinae

[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. ]

Clinical Neuroscience

[Consensus statement of the Hungarian Clinical Neurogenic Society about the therapy of adult SMA patients]

BOCZÁN Judit, KLIVÉNYI Péter, KÁLMÁN Bernadette, SZÉLL Márta, KARCAGI Veronika, ZÁDORI Dénes, MOLNÁR Mária Judit

[Background – Spinal muscular atrophy (SMA) is an autosomal recessive, progressive neuromuscular disorder resulting in a loss of lower motoneurons. Recently, new disease-modifying treatments (two drugs for splicing modification of SMN2 and one for SMN1 gene replacement) have become available. Purpose – The new drugs change the progression of SMA with neonatal and childhood onset. Increasing amount of data are available about the effects of these drugs in adult patients with SMA. In this article, we summarize the available data of new SMA therapies in adult patients. Methods – Members of the Executive Committee of the Hungarian Clinical Neurogenetic Society surveyed the literature for palliative treatments, randomized controlled trials, and retrospective and prospective studies using disease modifying therapies in adult patients with SMA. Patients – We evaluated the outcomes of studies focused on treatments of adult patients mainly with SMA II and III. In this paper, we present our consensus statement in nine points covering palliative care, technical, medical and safety considerations, patient selection, and long-term monitoring of adult patients with SMA. This consensus statement aims to support the most efficient management of adult patients with SMA, and provides information about treatment efficacy and safety to be considered during personalized therapy. It also highlights open questions needed to be answered in future. Using this recommendation in clinical practice can result in optimization of therapy.]