Lege Artis Medicinae

[Guidelines for the management of spontaneous pneumothorax]

A C Miller, J E Harvey

NOVEMBER 30, 1993

Lege Artis Medicinae - 1993;3(11)

[Simple flowcharts with explanatory notes have been prepared to assist in the immediate and subsequent care of patients presenting to emergency departments with spontaneous pneumothorax. These will help you to make decisions on: which patients are appropriate for hospital admission; whether drainage is necessary and, if so, the appropriate method (including technical details); hospitalisation; pulmonary consultation for hospitalised patients; and the organisation of follow-up. The guidelines, which are designed to be incorporated into emergency and other departmental manuals, have already proved valuable in the practice of several area general hospitals and can form the basis for further training. ]



Further articles in this publication

Lege Artis Medicinae

[Management of extremity injuries in mass catastrophes]


[The author details the characteristics of the management of extremity injuries in extreme conditions and describes the significant differences of injury management between extreme and peacetime circumstances. The theme is of great significance these days, owing to the rapidly rising frequency of military and civilian mass casualties and the parity of extremity injuries that reach up to 60%. The ideal devices, mental approach and organizational reflexes also differ from the traditional surgical routine to achieve an effective health service in catastrophe. Therefore preparation and training must be done in peacetime. The role of intuitions, improvisation and flexibility is very important, because there have not been two similar catastrophe situations yet and compromising management replaces the routine medical care. For fracture management special external fixators are preferable that have been developed and deviced for war injuries and that respect the budgetary and logistic aspects of catastrophe management.]

Lege Artis Medicinae

[Application of cytokine therapy in haematological diseases]


[The clinical applications of cytokines playing a role in regulation of haematopoesis are summarized. The potential clinical use of human cytokines can arbitrarily be ramified into 4 strategies: 1. Stimulation of the immune response in order to enhance immunosurveillance of neoplasms. 2. Prevention of chemotherapy and tumour related immuno- and myelosuppression and improvement of non-specific mechanisms of host resistance. 3. Increase of maximum tolerated doses of conventional antitumour chemotherapeutic regimens. 4. Direct influence on tumour cell growth and differentiation via cytotoxic, cytostatic or regulatory mechanisms. Three interferons, almost 6 different interleukins, erythropoetin and three different colony stimulating factors are presented. The potential benefits of cytokines in haematological malignancies and also the difficulties in realising this potential are discussed. ]

Lege Artis Medicinae

[Natural alfa interferon in the treatment of oral viral and virus associated diseases]

KÖVESI György, ONÓDY Klára, PÁLÓCZY Katalin, FEKETE Béla

[A native natural alfa interferon was applied in the treatment of 35 patients. The patients were suffering from oral virus infections (herpetic gingi vostomatitis, recurrent herpetic infections) and viral associated diseases (herpetic ulceration, recurrent aphthous ulcer, Sutton aphthous ulcer and postherpetic exudative erythaema). The patients received 1 or 2 million IU of alfa interferon im. daily for ten days. Laboratory investigations were carried out before and 10 days after the treatment. In addition to routine laboratory tests, we counted the number of absolute lymphocytes, LGL cells and immediate and late SRBC rosettes. In ten cases we noted the changes of the following surface markers: CD 2, CD 3, CD 4, CD 8, CD 11b, CD 14, CD 20, CD 25, CD 45, CD 45R and HLA-DR. There were no significant differences in the routine laboratory parameters before and after the treatment, whereas there were statistically significant increases in the number of LGL cells and in the count immediate and late rosettes. A significant increase in the expression of CD 8, CD 11b, CD 14, CD 25, and CD 45R also occurred. There were no adverse side effects interrupting the treatment. Alfa interferon seems to be useful in the treatment of these oral diseases. ]

Lege Artis Medicinae

[The role of ultrasonography in the detection of hip joint pseudoarthrosis infection]


[In the background of rest pain in pseudoarthrosis of the hip there may be synovitis of the pseudojoint, which can be infected as well. The author's aim was to examine what sort of help ultrasound can provide in clearing of the cause of rest pain occuring in pseudoarthrosis besides the other classical imaging methods. 14 patients undergone resection arthroplasty of the hip complaining of rest pain and 12 control subjects were examined. All of them had pelvic X ray and ultrasound examination of the pseudojoint. In two cases primer, in 24 cases secunder pseudoarthrosis had been formed. In the patient group with rest pain in 12 cases synovitis was detected by ultrasound and in 2 cases of the control group. Aspiration of the pseudo arthrosis was performed in 12 cases and in 8 of them synovial fluid was obtained. Two of them were infected originally. Synovitis was proved by arthrography in 4 cases. Ultrasound can help in the detection of synovitis of pseudojoint in patients under gone resection arthroplasty and therefore can help in making diagnosis of the infection and making decision of the therapeutic approach. ]

Lege Artis Medicinae

[Randomised Intervention Treatment of Angina trial]


[There were 16 deaths in the PTCA group and 18 in the CABG group. There was already a difference in the incidence of myocardial infarction between the two regimens (PTCA: 33, CABG: 20), but this was not statistically significant. 4% of those treated with PTCA required an emergency repeat of the procedure and a further 15% required CABG surgery during follow-up. Within two years, 38% of those treated with PTCA and 11% of those operated on required revascularisation. Coronary angiography had to be repeated four times more often in patients in the PTCA group than in those in the CABG group (31% versus 7%, p<0.001). Angina was also more common six months after PTCA (32%) than after surgery (11%), and those treated with dilatation were taking more antianginal drugs. One month after CABG, however, patients' physical workload was lower than after PTCA, although this difference disappeared later. Patients needed longer rehabilitation time after surgery than after PTCA, but those who underwent surgery had significantly less angina within two years and were less likely to need further diagnostic or therapeutic intervention.]

All articles in the issue

Related contents

Clinical Neuroscience

[What happens to vertiginous population after emission from the Emergency Department?]

MAIHOUB Stefani, MOLNÁR András, CSIKÓS András, KANIZSAI Péter, TAMÁS László, SZIRMAI Ágnes

[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmel­weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]

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. ]

Lege Artis Medicinae

[Thiazide- or thiazide-like diuretics should be used in the treatment of patients with hypertension? Particularities of the situation in Hungary]


[Diuretics have remained the cornerstone of the antihypertensive treatment since their widespreading in the 1960s. According to the 2018 ESC/ESH Guidelines for the management of arterial hypertension, in the absence of evidence from direct comparator trials and recognizing that many of the approved single-pill combinations are based on hydrochlorothiazide, this drug and thiazide-like indapamide can be considered suitable antihypertensive agents. In the 2018 Hungarian guidelines indapamide is named as the most efficacious diuretic in the treatment of patients with hypertension. The aim of the publication is redefining thiazide- and thiazide-like diuretic use in the treatment of hypertensive patients, with particular attention to presently available hydrochlorothia­zide and indapamide, and their combination drugs in Hungary.]

Lege Artis Medicinae

[Current issues in the peripartum management of diabetic women from the perspective of an internist-diabetologist]

KERÉNYI Zsuzsanna

[In pregnancy complicated with diabetes, treatment of hyperglycaemia is of fundamental importance during delivery in order to improve the outcome parameters of both the mother and the neonate. This is particularly important in the case of mothers with type 1 diabetes and of all mothers who require insulin treatment during their pregnancy. The use of antenatal steroids for women at risk of pre-term birth further complicates the treatment of hyperglycaemia in the period immediately before delivery and requires the appropriate change of insulin therapy. The requirement of nil per os in the delivery period necessitates proper fluid, glucose and insulin treatment in the pre-delivery hours. After surgical delivery the patients may also need infusion treatment until the first meal. As there is no unified guideline for the peripartum management of diabetes, the author re­views the international literature on the internal medicine issues concerning the peripartum treatment of pregnant women with diabetes. This study reviews the characteristics of insulin treatment of women with various types of diabetes before, du­ring and di­rect­ly after delivery. It presents a dosing schedule for women who needed an antenatal steroid treatment in the period before delivery due to premature birth for the purpose of lung maturation. The study also addresses the application and programming of pe­ripartum blood glucose tests, continuous interstitial glucose monitoring (CGM) and insulin pump treatment (CSII).]