Lege Artis Medicinae

[Lucky source of money]

OCTOBER 28, 1992

Lege Artis Medicinae - 1992;2(10)

[In creating the Gambling Act, Parliament decided that the lottery and the lottery, casinos, bingos, bongos and other proliferating games of chance to the permanent losers of the central budget - health, social policy, culture, education and sport. This is no small sum, with some HUF 1.2 billion available this year alone for the Gambling Fund set up by Szerencsejáték Rt.]

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Lege Artis Medicinae

[Diagnosis and treatment of acute obstetrical DIC]

RÁKÓCZI István

[Modern management of acut obstetrical diffuse intravascular coagulation (DIC) was evaluated. A large variety of obstetrical conditions are associated with acute DIC such as amniotic fluid embolism, abruptio placentae, intrauterine infection (septic abortion), dead fetus syndrome and prolonged shock of any aetiology. Typically, acute obstetrical DIC is associated with haemorrhage (mainly vaginal bleeding) and shock. The whole blood coagulation time, platelet count and fibrinogen level are the most clinically useful indicators in evaluating the patient with acute DIC. Management of acute DIC includes prompt treatment of precipitating factors (delivery of fetus in placental abruption, evacuation of the uterus in septic abort union plus administration of antibiotics, delivery of a dead fetus by induction of labor). Careful attention to fluid and blood cell replacement is needed to prevent and treat hemorrhagic shock. The coagulation failure is treated with fresh-frozen plazma or cryoprecipitate and platelets. In acute obstetrical DIC complicated by hemorrhage heparin has no use and will only cause the bleeding to worsen. Recently several clinical studies indicate that antithrombin III concentrates are efficacious in DIC.]

Lege Artis Medicinae

[Disseminated intravascular coagulation in the newborn]

GOLDSCHMIDT Béla

[A review is given on disseminated intravascular coagulation in the newborn period. DIC is not a single disease entity, but a complication of several underlying diseases. The author summarizes the physiologic and pathophysiologic conditions which promote the development of this blood coagulation disorder in this age. Further on the clinical symptoms, the difficulties of laboratory analysis as well as of differential diagnosis are discussed. Finally a detailed description of the treatment of the neonatal DIC syndrome is given. ]

Lege Artis Medicinae

[The risk of ischemic heart disease in patients with ischemic cerebrovascular disease]

HORVÁTH Sándor

[A strong association is supported between ichemic cerebrovascular and heart diseases by several studies. Death is more commonly caused by myocardial infarction than by stroke itself in patients with asymptomatic carotid stenosis, amaurosis fugax, transient ischemic attack or ischemic stroke. Signs and symptoms of ischemic cerebrovascular diseases or asymptomatic atherosclerosis of the arteries of the neck are harbinger for both myocardial and cerebrovascular infarction. Patients suffering from ischemic cerebrovascular diseases should be routinely investigated, treated and cared for coronary artery disease in order to prolong survival. ]

Lege Artis Medicinae

[Results and perspective of gene therapy in the treatment of primary immunodeficiency]

SÓFI Gyula, MARÓDI László

[During the last decade research has been directed toward gene-replacement therapy of genetic disorders, including primary immunodeficiencies. Efficient methods for gene transfer were developed to correct the gene defect in adenosine desaminase deficiency, leukocyte adhesion deficiency and chronic granulomatous disease. Somatic gene therapy in a patient with ADA deficiency was performed two years ago. This paper summaries inicial clinical applications of gene transfer and gene therapy in primary immunodeficiency and the future prospects of gene therapy in cohort of patients. ]

Lege Artis Medicinae

[Third International Study of Infarct Survival]

MATOS Lajos

[There was no significant difference in 35-day mortality between the aspirin + heparin and aspirin-only groups. The incidence of re-infarction was slightly lower with aspirin plus heparin (2p <0.09). When patients also received heparin in addition to aspirin, transfusion was needed more often and non-cerebral haemorrhage was more frequent (2p < 0.01) Combining the results of ISIS-3 and GISSI-2, mortality was significantly reduced during the treatment period (p < 0.01). There was no appreciable difference in mortality or re-infarct incidence between the use of streptokinase or APSAC, but there were more allergic events in the APSAC group. There was no difference in 6-month survival between the two groups. There was no difference in the efficacy of streptokinase and tPA treatment at either 0-35 days or 6 months survival. Allergies were less frequent with tPA, but non-cerebral haemorrhage was more frequent. Treatment with tPA led to stroke significantly more often than streptokinase (2p < 0.01). Combining the data from the similar GISSI-2 trial and ISIS-3, no difference was observed between streptokinase and tPA in either mortality between 0-35 days or survival at 6 months. ]

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Clinical Neuroscience

A new method to determine the optimal orientation of Slim Modiolar cochlear implant electrode array insertion

HORVÁTH Bence, PERÉNYI Ádám, MOLNÁR Fiona Anna, CSANÁDY Miklós, KISS József Géza, ROVÓ László

Our goal was to determine the optimal orientation of insertion of the Slim Modiolar electrode and develop an easy-to-use method to aid implantation surgery. In some instances, the electrode arrays cannot be inserted in their full length. This can lead to buckling, interscalar dislocation or tip fold-over. In our opinion, one of the possible reasons of tip fold-over is unfavourable orientation of the electrode array. Our goal was to determine the optimal orientation of the Slim Modiolar electrode array relative to clear surgical landmarks and present our method in one specified case. For the measurement, we used the preoperative CT scan of one of our cochlear implant patients. These images were processed by an open source and free image visualization software: 3D Slicer. In the first step we marked the tip of the incus short process and then created the cochlear view. On this view we drew two straight lines: the first line represented the insertion guide of the cochlear implant and the second line was the orientation marker (winglet). We determined the angle enclosed by winglet and the line between the tip of the incus short process and the cross-section of previously created two lines. For the calculation we used a self-made python code. The result of our algorithm for the angle was 46.6055°. To validate this result, we segmented, from the CT scan, the auditory ossicles and the membranaceous labyrinth. From this segmentation we generated a 3D reconstruction. On the 3D view, we can see the position of the previous lines relative to the anatomical structures. After this we rotated the 3D model together with the lines so that the insertion guide forms a dot. In this view, the angle was measured with ImageJ and the result was 46.599°. We found that our method is easy, fast, and time-efficient. The surgery can be planned individually for each patient, based on their routine preoperative CT scan of the temporal bone, and the implantation procedure can be made safer. In the future we plan to use this method for all cochlear implantation surgeries, where the Slim Modiolar electrode is used.

Clinical Neuroscience

[Epidemiology, cost and economic impact of cerebral palsy in Hungary]

FEJES Melinda, VARGA Beatrix, HOLLÓDY Katalin

[Objective - The purpose of our communication was to determine the total cost of cerebral paretic patients in Hungary between 0 and 18 years and to assess their impact on the national budget. Methods - Based on the data of Borsod county we calculated the CP characteristics. The cost of CP was determined by routine care of individuals. Lost Parental Income and Tax were calculated on the basis of average earnings. The ratio of GDP, Health and Social Budget and Health Budget to CP is based on CP annual average cost and frequency. We have developed a repeatable computational model. Results - Of the risk groups, premature birth (30.97%), low birth weight (29.64%), perinatal asphyxia (19.47%) were the most common. Source is unknown of 37.61% of the cases. CP prevalence was 2.1‰. The two-sided (59.7%) and the one-sided (19.0%) spastic pareses dominated. The most serious form is the two-sided spastic paresis (42.5% GMFCS 3-5 degrees). Epilepsy was 22.0%, incontinence was 27%, mental involvement was 46%. Care for one child up to 18 years of age costs an average of 73 million HUF (€ 251,724). The lost family income was 27.36 million HUF (€ 94,345), and lost tax and health care contributions were 14.46 million HUF (€ 49,862). Additionally, 0.525% of the GDP, 0.88% of the full health and social budget and 1.83% of direct medical costs were spent for CP families. Conclusion - The cost of CP disease is significant. Costs can be reduced by improving primary prevention. From the perspective of the family and government, it is better to care for families so they can take care of their disabled children.]

Clinical Neuroscience

EEG-based connectivity in patients with partial seizures with and without generalization

DÖMÖTÖR Johanna, CLEMENS Béla, EMRI Miklós, PUSKÁS Szilvia, FEKETE István

Objective - to investigate the neurophysiological basis of secondary generalization of partial epileptic seizures. Patients and methods - inter-ictal, resting-state EEG functional connectivity (EEGfC) was evaluated and compared: patients with exclusively simple partial seizures (sp group) were compared to patients with simple partial and secondary generalized seizures (spsg group); patients with exclusively complex partial seizures (cp group) were compared to patients with cp and secondary generalized seizures (cpsg group); the collapsed sp+cp group (spcp) was compared to those who had exclusively secondary generalized seizures (sg group). EEGfC was computed from 21-channel waking EEG. 3 minutes of waking EEG background activity was analyzed by the LORETA Source Correlation (LSC) software. Current source density time series were computed for 23 pre-defined cortical regions (ROI) in each hemisphere, for the 1-25 Hz very narrow bands (1 Hz bandwidth). Thereafter Pearson correlation coefficients were calculated between all pairs of ROI time series in the same hemisphere. Z-scored correlation coefficients were compared at the group level (t-tests and correction for multiple comparisons by local false discovery rate, FDR). Results - Statistically significant (corrected p<0.05) EEGfC differences emerged at specific frequencies (spsg > sg; cpsg > cp), and at many frequencies (sg > spcp). The findings indicated increased coupling between motor cortices and several non-motor areas in patients with partial and sg seizures as compared to patients with partial seizures and no sg seizures. Further findings suggested increased coupling between medial parietal-occipital areas (structural core of the cortex) and lateral hemispheric areas. Conclusion - increased inter-ictal EEGfC is associated with habitual occurrence of secondary generalized seizures.

Clinical Neuroscience

[EEG-based cerebral networks in 14 neurological disorders]

DÖMÖTÖR Johanna, CLEMENS Béla, CSÉPÁNY Tünde, EMRI Miklós, FOGARASI András, HOLLÓDY Katalin, PUSKÁS Szilvia, FEKETE Klára, KOVÁCS Attila, FEKETE István

[Background - Brain networks have not been systematically investigated yet in most neurological disorders. Purpose - To investigate EEG functional connectivity (EEGfC) networks in 14 neurological disorders. Patients - Potentially eligible patients were collected from clinical and EEG databases. All the available clinical data and EEG records were critically revised. All the patients who suffered of a single neurological disorder (out of the 14) and had a good quality EEG recording entered the study. Confoundig factors as comorbidity and CNS-active drug effects were eliminated as far as possible. EEG analysis - Three minutes of resting-state, waking EEG activity were selected for analysis. Current source density (CSD) values were computed for 2394 cortical voxels by Low Resolution Electromagnetic Tomography (LORETA). Thereafter, Pearson correlation coefficients were computed between all pairs of 23 cortical regions of interest (ROI) in each hemisphere (LORETA Source Correlation, LSC software). Computation was carried out for conventional EEG broad bands and very narrow bands (1 Hz bandwidth) between 1 and 25 Hz as well. Correlation coefficients of each group were statistically compared to our normative EEG (LSC) database by two-talied t-tests. Bonferroni-corrected p<0.05 values were accepted as statistically significant, and were graphically displayed as topographical networks. Results and conclusion - Group-specific networks were demonstrated. However, non-specific networks, charasteristic for most groups, were detected as well. Common finding were: decreased connectivity in the alpha band and increased connectivity in the delta, theta bands and upper-beta band. Decreased alpha-band connectivity presumably reflected primary lesional effects and on the other hand, non-specific vulnerability of “rich club connections”. Increased connectivity in the slow bands presumably indicated adaptive-compensatory activity of brain homeostasis. ]

Lege Artis Medicinae

[About stem cells]

PAPP Csaba

[Stem cells are special cells of an organism that are capable to continuously renew themselves and, triggered by environmental effects, to differentiate and produce cells suitable for various functions. Due to their special characteristics, stem cells have an exciting potential to fulfil an old dream of physicians: to replace and regenerate damaged cells and tissues. Regenerative medicine has undoubtedly opened new vistas in medicine and provides hope for those with yet uncurable diseases. Here, we briefly describe different kinds of stem cells and their sources and discuss some of their experimental or clinical applications. Besides the bone marrow, which is now considered a traditional stem cell source, we present alternative sources. Among these, we pay special attention to the two stemcell sources that are important for obstetricians and gynaecologists: the umbilical cord (Wharton’s jelly) and the characteristics of the umbilical cord blood. We discuss some aspects of the storage of cord blood (”stem cell banking“) its potential use. Obstetricians and gynaecologists have an important role and a great responsibility in promoting the collection and, if necessary, the use of these stem cells. Communicating with patients and informing them about the their possible therapeutic applications stem cells is a part of this process as well as obtaining cord blood and preserving a segment of the cord. Obstetricians and gynaecologists should help to save as much as possible the umbilical cord and cord blood, which become ”redundant“ after birth but are a great source of multipotent mesenchymal and haemopoietic stem cells, which can be used in various fields of 21st-century medicine.]