Lege Artis Medicinae

[How Psychoanalytic Psychobiography was Born ]

KŐVÁRY Zoltán

SEPTEMBER 20, 2017

Lege Artis Medicinae - 2017;27(08-09)

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Lege Artis Medicinae

[Cardiovascular screening and risk stratification]

VÉRTES András

[Cardiovascular diseases are still leading cause of death in developed countries. A possible background, atherosclerosis, might appear even in childhood, and deteriorate during the years without any symptoms. The cardiovascular prevention is a complex activity, which can be observed in population or/and in individual level. The conventional screening means the assessment of higher cholesterol level, blood pressure or other risk factors in healthy population without symptoms. The point of clinical risk evaluation is to find patient with high cardiovascular risk and consequentially with the necessity of intensive preventive strategy. For the right cardiovascular screening and adequate evaluation of the risk, it is needed that the doctors who frequently meet with the population execute the above-mentioned risk assessment. Therefore doctors, nurses, and education for preventive aspect would is needed, as education is important to decrease cardiovascular mortality for those patients that were categorized as a high-risk group.]

Lege Artis Medicinae

[The László Romics Award – to Boost the Young An Interview with Professor István Karádi ]

KUN J. Viktória

Lege Artis Medicinae

[Effective fulvestrant treatment of indolent breast cancer in a patient with low compliance - a case report]

HÓDI Veronika

[In the explosive development of treatment of oncological patients, there are still patients who are not always cooperative even in their own treatment. The case report exemplifies that even in this case the endocrine treatment has its place in the hormone receptor positive breast cancer. ]

Lege Artis Medicinae

[Love or Thirst for Revenge or Forgiving – Flowing Melodies, a Virtuoso Play A Concert-like Performance of Bellini’s Last Opera in Budapest and in Pécs ]

WINKLER Gábor

Lege Artis Medicinae

[Advance directive]

KŐMÜVES Sándor

[In the first step the work defines the institution of advance directive, places advance directive in the context of advance care planning, and demonstrates the advantages of advance care planning. Then the forms of the advance directive are presented and related Hungarian health care sections are interepreted in the context of these back-ground conditions. In the third step decision making capacity is defined, its standards are set out, the role of substituted decision maker is delineated. In the fourth step accumulated experience with living will is demonstrated and the possible alternatives concerning the future of living will are provided: the elimination of the living will part of the institution from health care or its continued application after substantial revision. METHODS - Analytic presentation after systematic review of the literature on the topic. RESULTS - Significant experience has been accumulated since the implementation of advance directive. In light of experience two attitudes have been chrystallized regarding the future of the institution: one takes the side of the elimination of the living will part of the institution from health care, the other recommends its revised application. CONCLUSION - The American and Hungarian experiences with advance directive recommend the review of the Hungarian institution of advance directive. ]

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Clinical Neuroscience

Extraskeletal, intradural, non-metastatic Ewing’s sarcoma. Case report

OTTÓFFY Gábor, KOMÁROMY Hedvig

Intracranial localization of Ewing’s sarcoma is considerably very rare. Herein, we present clinical and neuroimaging findings regarding a 4-year-old boy with intracranial Ewing’s sarcoma. He was born prematurely, suffered intraventricular haemorrhage, posthaemorrhagic hydrocephalus developed, and a ventriculoperitoneal shunt was inserted in the newborn period. The patient endured re­gular follow ups, no signs of shunt malfunction nor increased intracranial pressure were observed. The last neuroima­ging examination was performed at 8 months of age. Upon reaching the age of 4 years, repeated vomiting and focal seizures began, and symptoms of increased intracranial pressure were detected. A brain MRI depicted a left frontoparietal space-occupying lesion infiltrating the superior sagittal sinus. The patient underwent a craniotomy resulting in the total excision of the tumour. The histological examination of the tissue revealed a small round blue cell tumour. The diagnosis was confirmed by the detection of EWSR1 gene translocation with FISH (fluorescent in situ hybridization). No additional metastases were detected during the staging examinations. The patient was treated in accordance to the EuroEwing 99 protocol. Today, ten years onward, the patient is tumour and seizure free and has a reasonably high quality of life.

Journal of Nursing Theory and Practice

[American Heroine of home care nursing and social care, Lillian D. Wald was born 150 years ago]

BALOGH Zoltán, BALOGH Ádám, MISI Adelina

Lege Artis Medicinae

[Selective abortion in twin pregnancies discordant for congenital fetal anomaly]

PATKÓS Péter, HRUBY Ervin, PAPP Csaba, TÓTH-PÁL Ernő, PAPP Zoltán

[INTRODUCTION - In special cases of twin pregnancy where one of the fetuses is affected by severe congenital anomaly or disease confirmed with prenatal diagnostic methods and the other fetus is healthy, selective abortion has been accepted as the method of choice for twenty years to save the healthy sibling and to improve its life expectations. PATIENTS AND METHODS - The authors present their clinical experience of the past 15 years from 14 cases of selective abortion performed in twin pregnancies discordant for congenital fetal anomaly. Indication for the intervention was the anomaly of the second fetus in eleven cases and the anomaly of the first twin fetus in three cases. RESULTS - Out of eleven selective abortions performed on the second twin fetus, only one ended with the loss of the entire pregnancy. All three cases of selective abortion performed on the first twin fetus resulted in abortion of the entire twin pregnancy. All ten surviving fetuses were born living and healthy, followed by unharmed infant and childhood development. CONCLUSIONS - To offer the possibility of selective abortion to the parents seems to be indicated only in those cases of twin pregnancy where the discordant fetal disease or congenital anomaly is severe, placentation is dichorionic or at least diamniotic and where the second twin is affected.]

Lege Artis Medicinae

[Specialists’ mobility in surgery and gynaecology-obstetrics in Hungary]

BALÁZS Péter

[The new government inaugurated in 2006, started a most comprehensive professional and territorial restructuring of the hospital network in the recent decades. While performing it, the health administration took in account also the considerable re-allocation of the domestic medical workforce. The joint mobility program launched by the Ministry of Health and the Ministry of Social Affairs and Labour supported doctors and nurses changing their habitation provided they had lost their working place by reorganisations. The obvious failure of this program indicated very clearly the lack of mobility of involved physicians (only 24 physicians and 11 nurses applied to be supported). The present study based on data of registered specialists in December 2009 analyses the graduate training and professional mobility patterns of surgeons and gynaecologist-obstetricians born in Hungary and abroad as well. Among surgeons (N=1469) there is 13.5% and among gynaecologist-obstetricians (N=1377) 10.6% the proportion of those born abroad. Results obtained show a very strong adherence of domestic professionals to the regional community, however this adherence exists parallel with the crossnational migration of the same workforce both indicating the essential role of immigrant specialists while providing health care in this country.]

Lege Artis Medicinae

[Making the Female Face Ugly, or How Modern Painting was Born? ]

GEREVICH József