Lege Artis Medicinae

[Hospital management questions in the LAM Club]

ANDRÁS László

AUGUST 26, 1992

Lege Artis Medicinae - 1992;2(08)

[István Mikola, Director General of the László Hospital in Budapest and President of the Hungarian Hospital Association, made the above statements at a meeting of the Parliament's Social Affairs Committee, in the presence of 22 of his colleagues from the capital's hospital directors. On the eve of the reform of specialised care, including inpatient care, and in the midst of the funding crisis, it was timely to hold a debate on hospital management issues at the LAM Club.]

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[The significance of interleuktin-6, it's molecular regulation in acute phase reaction]

FALUS András, BÍRÓ Judit, RÁKÁSZ Éva

[The multiple effectiveness of a hormone-like cytokine, interleukin-6 (IL-6) is highly important in a series of immunological, neuroendocrinological and inflammatory reactions of the mammalian organism. In this review a complex view of the gene and its regulation of IL-6 and the significance of the cytokine network in acute phase reaction is discussed. Manipulation of this complex network studied by the methodology of molecular biology and genetics provides entirely new approaches for the biotechnological and pharmacological regulation of inflammation.]

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[Call for support for the Healthy Breasts Foundation]

MONOS Emil

[Hungary is one of the world's leading countries in the grim international statistics on cardiovascular disease mortality, with around 80 000 people dying every year from serious cardiovascular disorders. This figure represents nearly 55% of all deaths! The vast majority of heart disease is related to the failure of the heart's own coronary arteries, and a significant proportion of brain disease is related to damage to the brain vessels themselves.]

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[The application of argon laser in cosmetological therapy]

DIMITRIJE Katalinic

[The author was one of the first in 1976 who began to use the various types of lasers for plastic-esthetical reasons and for therapy of skin lesions. He considers the indication spectrum of the argon laser to be the largest and its results are the best. The author summarizes and makes known the tissue-effects of the argon laser and compaes it with the tissue-destruction of other lasers and classical methods. The quality of the tissue destruction determines the indications and the applications, among them the therapy of the port wine syndrome. In the author's opini on, not the exposition time and the energy of the argon laser could be exactly determined. The experience of the physician plays the most important tole in the therapy. ]

Lege Artis Medicinae

[The mode of action of bath therapy]

BENDER Tamás

[Bath therapy includes both hydro- and balneotherapy. During hydrotherapy the patient is treated by the physical parameters of the water. The effect of balneotherapy is based on the penetration of the mineral water. Its me chanism is not yet clear. There are several double-blind studies which prove the benefits of balneotherapy. Further studies are needed to judge the objective effects of balneotherapy. ]

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[Correlation between clinical data and histologycal findings assessing the severity of ulcerative colitis]

NAGY Ferenc, KARÁCSONY Gizella

[ A knowledge of the current activity of ulcerative colitis is essential in planning appropiate follow-up. Histological findings obtained from 209 colonoscopies were compared with the values of 22 clinical variables. One way analysis of variance was carried out. Of the 22 variables 11 proved to be significantly different between the groups of the clinically valuable classification (inactive, chronic, acute). Each of the three groups differed in the number of bloody stools. The acute inflammatory process was characterized by the high numbers of bowel movements, mucus and bloody mucus defecation, bowel movements at night, and haematocrit values suggesting anaemia. The serum iron levels in the inactive group differed significantly from the levels of both the acute and the chronic groups. The count of thrombocyte and the general well being were found to be valuable only in the differentiation between the acute and the inactive inflammatory processes. The computed haematocrit value proved to be useful in distinguishing the acute stage from the inactive and the chronic process. Out of the 22 variables only 11 had clinical importance in the evaluation of the activity of ulcerative colitis. ]

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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.

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[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

[A short chronicle of three decades ]

KAPRONCZAY Katalin

[Hungarian professional periodicals started quite late in European context. Their publish­ing, editing and editorial philosophy were equally influenced by specific historical and political situations. Certain breaking points of history resulted in termina­tion of professional journals (War of In­de­pendence 1848-1849, First and Se­cond World Wars), however there were pe­riods, which instigated the progress of sciences and founding of new scientific journals. Both trends were apparent in years after the fall of former Hungarian regime in 1990. The structure of book and journal publishing has changed substantially, some publishers fell “victim” others started successfully as well. The latters include the then-established publishing house Literatura Medica and its own scientific journal, Lege Artis Me­di­cinae (according to its subtitle: New Hun­garian Medical Herald) issued first in 1990. Its appearance enhanced significantly the medical press market. Its scientific publications compete with articles of the well-established domestic medical journals however its philosophy set brand-new trends on the market. Concerning the medical community, it takes on its problems and provides a forum for them. These problems are emerging questions in health care, economy and prevention, in close interrelation with system of public health institutions, infrastructure and situation of those providing individual health services. In all of them, Lege Artis Medicinae follows consequently the ideas of traditional social medicine.]