Lege Artis Medicinae

[History of the Health Science Council (1868-1990) Part II]

GÁL György

MARCH 30, 1994

Lege Artis Medicinae - 1994;4(03)

[The reorganisation of the Scientific Council for Health was reintroduced in 1976 due to its overcrowding and unwieldiness. Its operation was regulated by the Minister of Health, Dr. Emil Schultheisz, in his Instruction No. 31/1976 EüK. 23/EC/M. The Council operated on this basis until 1 June 1989. The Instruction contained, inter alia, the following provisions: ]

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[In Hungary, hormone replacement therapy (HRT) has been used more extensively in the last few years. The benefits of HRT in cardio vascular diseases, osteoporosis and quality of life have been well established. Breast cancer and endometrial carcinoma have been considered as contraindications for HRT. A reappraisal of this practice is necessary since we have no evidence that HRT may adversely influence the outcome of these tumours, al though this is theoretically possible since the effect of estrogens on occult metastases is unknown. The relationship between replacement therapy and the uterine sarcomas is of particular concern. HRT is safe in patients successfully treated for carcinoma of the vulva, vagina, uterine cervix and in those with ovarian cancer. Experience suggests that estrogen can also be used safely in women treated previously for endometrial cancer. As far as breast cancer is concerned, it appers logical to discuss the risk-benefit considerations with our patients before embarking on using HRT. Consultation with a gynaecological oncologist prior to HRT in patients with endometrial and/or breast cancer is strongly recommended. ]

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[The home-care and hospice movement has been sporadically encountered in the hospital and care network for a long time, and we have already seen all that this paper aims to do. Across the country, hospitals and specialist outpatient departments alike are seeking ways and means of providing this care. ]

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KESZLER Pál, RÁCZ Egon

[Dear Editorial Team! In the 30 November 1993 issue, AC Miller and JE Harvey's "Guidelines for the management of spontaneous pneumothorax" was published as a position paper of the British Thoracic Society. It may seem an ungrateful undertaking to enter into a debate with the principles of such a venerable and long-established society.]

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[Infectious diseases caused by bacteria have been treated successfully by antibiotic the rapy for the past half century, and a diversity of antibacterial agents with widely differing mechanisms of action has been developed by the pharmaceutical industry. However the selective pressure of antibiotic usage has inevitably led to the isolation of resistant bacteria and the rate of emergence of antibiotic resistance appears to be increasing rapidly, reducing the effectiveness of existing agents. Factors responsible for the wide dissemination of antibioticresistant bacteria in both community and hospital practice include the acquisition and spread of resistant genes by plasmids and transposons, inappropriate anti biotic usage and social factors. Mechanisms to controll the emergence of antibiotic resistance require optimal usage of antibiotics by clinicians, control programmes to improve hygiene and to reduce the transmission of resistant bacteria within and between communities, and the continued development of new antibacterial agents.]

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[In the palliative treatment for patients with highly located and/or intrahepatic malignant biliary stenoses or obstructions interventional radiological procedures may play a significant part. In 12 patients with obstructive jaundice caused by highly located malignant stenosi(es) or obstruction(s) 23 endoprostheses were implanted. In 5 cases double endoprosthesis placement was performed to connect isolated lobes or segments of the liver. Patients' survival was 4–22 (average 8, 7) months. In 6/12 patients surviving for 4-8 months, occlusion of the endoprostheses did not occur. In the other half of the patients, in whom the disease permitted a longer life-expectancy, prosthesis occlusion led to recurrent jaundice within 3–11 months. In all but one case, in which endoscopic exchange was successful, percutaneous interventions were necessary. Successful endoprosthesis placement was carried out 3 times in one patient and once each another 5 patients following percu taneous extraction (3 times), distal displacement (twice) and endoscopic removal (twice) of the occluded endoprostheses. Authors consider percutaneous endoprosthesis placement an effective procedure in the palliative treatment of the aforementioned patients' group, both for improving their survival and quality of life. They emphasize the fact that lengthy and difficult manipulations are required for these procedures which consequently result in a considerable amount of scattered radiation exposure to those performing the procedures.]

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