Lege Artis Medicinae

[More pains of labour]


MAY 29, 1991

Lege Artis Medicinae - 1991;1(09-10)

[No luck for the Hungarian Medical Chamber's Bureau draft law to discuss the draft law with MPs. About six months ago, the Social Affairs Committee wanted to put the draft on its agenda for debate, but was thwarted by the question of form, which was only apparently a question of form, but in fact of substance: if it is a draft law, who submitted it to the parliamentary committee. A professional body is not entitled to do that. On this basis, the Members did not wish to discuss it at the time - at least now, and let us be precise here! - the draft chamber bill. Since then, the Presidency of the Chamber has revised the drafting in a public debate, has thoroughly liberalised it and would have liked to present it to the Members of Parliament who are doctors, and discuss it, now wisely calling it a working document. Such a meeting is not a statutory forum, has no agenda, and is not intended to be a lobbying exercise in the good sense.]



Further articles in this publication

Lege Artis Medicinae

[Intendation: the principle hypothesis for conductive education]

HÁRI Mária

[The Conductive Education System has got special attention in the recent decade as an alternative form of integrating disabled persons to society (normalization). The primary goals of the system are costruction of an active life pattern, improvement of the cognitive functions and fulfilment of requirements of a complex and unified programme. This process is special in the (re)habilitation of the motor disabled. Instead of the sensomotoric teaching of orthofunction, its cognitive approach serves the learning of intendation and makes possible the development of orthofunctional spontaneity. Between 1968–88. 9772, 0–14 year old disabled children were registered, and 71% of them admitted. 80% of the younger age group, and 60% of the elder succeeded in integration. In the first half of 1989 80% of 268 children suffering mainly from cerebral palsy were admitted. The special formation of the groups, preparing for work and life, planning of the special education and running the program need well trained conductor staff. ]

Lege Artis Medicinae

[Diagnosis and treatment of neck pain]


[Neck pain is a frequent syndrome; numerous diseases may stand in its background from a transient myalgia to vertebral malignoma. Thus its diagnostics has a great importance in the everyday practice of the general practicioners. After a short summary of the anatomic features and aetiopathogenesis, the article analizes the anamnesis and physical examination as well as the elements of radiology and laboratory tests. The most important characteristic features of the cervical syndromes, according to leading symptoms are summarized. ]

Lege Artis Medicinae

[Clinical aspects of congenital thrombophilia]

DOMJÁN Gyula, PÁL András, PETŐ Iván, SAS Géza

[In the recent decades the name ,,thrombophilia" has been accepted to denote the congenital, mostly inherited susceptibility to thromboses. The increased coagulability (hypercoagulation) is supposed to be the main cause of the evolution of congenital thrombophilia. Antithrombin III has an outstanding importance to neutralize the active factors developing in the course of the coagulative process, and heparin-cofactor 11 has become known recently. Protein C and protein S are also important regulators. The increased coagulability can be caused by congenital disturbances of the formation of fibrinogen and plasminogen and also by the decreased activity of the fibrinolytic system. Recently, we recognised several cases, where the cause of thrombophilia was simultaneous absence of two inhibitors of coagulation. We attach importance to those cases as well when the inherited defect of one inhibitor and a congenital metabolic disturbance occure together. The diagnosis of congenital thrombophilia needs a long series of laboratory tests. In the course of the treatment results can be expected from thrombolysis, probably from vascular surgical interventions and – in non recent cases – from anticoagulation. The substitution treatment is getting more important in these inhibitor deficiencies.]

Lege Artis Medicinae

[Predictive value of allergic rhinitis for bronchial asthma in childhood]


[Asthmatic manifestations can be expected in 20 to 30% of children with allergic rhinitis. Risk factors were searched to predict later bronchial asthma in time. In a prospective study family history, clinical symptoms and laboratory signs, bronchial hyperreactivity (to histamine and to adenosine) and the lymphocyte beta-adrenergic receptor affinity and number were investigated. 31 of 40 patients responded with bronchoconstriction to histamin and 20 to adenosine. In 16 patients both provocation tests were positive. There was no significant difference in lymphocyte beta-adrenergic receptors between the patient group and the controls. It is suggested that children with allergic rhinitis who show bronchial hyperreactivity and a decreased number or affinity of lymphocyte beta-adrenergic receptors are more at risk to asthmatic manifestations. The risk is higher as the number of receptors decreases with age. The prognostic value of the above mentioned methods will be demonstrated by a subsequent retrospective study.]

Lege Artis Medicinae

[A consultation program for planning insulin therapy]


[This paper describes a decision support system aimed to assist the day-to-day management of insulin treated diabetic patients based on blood glucose measurements. The therapeutic advices are generated by a multistep procedure involving qualitative reasoning to determine the direction of adjustments and numerical simulation of insulin effect on glycaemia to quantify the extent of control actions to achieve glucose control corresponding to the pre selected targets. The qualitative reasoning module uses meal time oriented glucose balances and distances from the glucose target values to guide the search for appropriate control actions. The simulation module contains a physiologically based glucose-insulin model which generates a 24 hour prediction of the patient's blood glucose profile based on these adjustments which allows the doctor to select the optimal control action from alternatives. The results of a preliminary study to compare the advices given by the system to that of an independent diabetologist are also presented for 11 patients.]

All articles in the issue

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Clinical Neuroscience

Cases of inborn errors of metabolism diagnosed in children with autism

CAKAR Emel Nafiye, YILMAZBAS Pınar

Autism spectrum disorder is a neurodevelopmental disorder with a heterogeneous presentation, the etiology of which is not clearly elucidated. In recent years, comorbidity has become more evident with the increase in the frequency of autism and diagnostic possibilities of inborn errors of metabolism. One hundred and seventy-nine patients with diagnosis of autism spectrum disorder who presented to the Pediatric Metabolism outpatient clinic between 01/September/2018-29/February/2020 constituted the study population. The personal information, routine and specific metabolic tests of the patients were analyzed retrospectively. Out of the 3261 patients who presented to our outpatient clinic, 179 (5.48%) were diagnosed with autism spectrum disorder and were included in the study. As a result of specific metabolic examinations performed, 6 (3.3%) patients were diagnosed with inborn errors of metabolism. Two of our patients were diagnosed with classical phenylketonuria, two with classical homocystinuria, one with mucopolysaccharidosis type 3D (Sanfilippo syndrome) and one with 3-methylchrotonyl Co-A carboxylase deficiency. Inborn errors of metabolism may rarely present with autism spectrum disorder symptoms. Careful evaluation of the history, physical examination and additional findings in patients diagnosed with autism spectrum disorder will guide the clinician in the decision-making process and chose the appropriate specific metabolic investigation. An underlying inborn errors of metabolism may be a treatable cause of autism.

Clinical Neuroscience

Evaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations

EVRAN Sevket, KATAR Salim

Far lateral lumbar disc herniations (FLDH) consist approximately 0.7-12% of all lumbar disc herniations. Compared to the more common central and paramedian lumbar disc herniations, they cause more severe and persistent radicular pain due to direct compression of the nerve root and dorsal root ganglion. In patients who do not respond to conservative treatments such as medical treatment and physical therapy, and have not developed neurological deficits, it is difficult to decide on surgical treatment because of the nerve root damage and spinal instability risk due to disruption of facet joint integrity. In this study, we aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) on the improvement of both pain control and functional capacity in patients with FLDH. A total of 37 patients who had radicular pain caused by far lateral disc herniation which is visible in their lumbar magnetic resonance imaging (MRI) scan, had no neurological deficit and did not respond to conservative treatment, were included the study. TFESI was applied to patients by preganglionic approach. Pre-treatment Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared with the 3rd week, 3rd month and 6th month scores after the procedure. The mean initial VAS score was 8.63 ± 0.55, while it was 3.84 ± 1.66, 5.09 ± 0.85, 4.56 ± 1.66 at the 3rd week, 3rd month and 6th month controls, respectively. This decrease in the VAS score was found statistically significant (p = 0.001). ODI score with baseline mean value of 52.38 ± 6.84 was found to be 18.56 ± 4.95 at the 3rd week, 37.41 ± 14.1 at the 3rd month and 34.88 ± 14.33 at the 6th month. This downtrend of pa­tient’s ODI scores was found statistically significant (p = 0.001). This study has demonstrated that TFESI is an effective method for gaining increased functional capacity and pain control in the treatment of patients who are not suitable for surgical treatment with radicular complaints due to far lateral lumbar disc hernia.

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. ]

Hypertension and nephrology

[Association between cyclothymic affective temperament and hypertension]


[Affective temperaments (cyclothymic, hypertymic, depressive, anxious, irritable) are stable parts of personality and after adolescent only their minor changes are detectable. Their connections with psychopathology is well-described; depressive temperament plays role in major depression, cyclothymic temperament in bipolar II disorder, while hyperthymic temperament in bipolar I disorder. Moreover, scientific data of the last decade suggest, that affective temperaments are also associated with somatic diseases. Cyclothymic temperament is supposed to have the closest connection with hypertension. The prevalence of hypertension is higher parallel with the presence of dominant cyclothymic affective temperament and in this condition the frequency of cardiovascular complications in hypertensive patients was also described to be higher. In chronic hypertensive patients cyclothymic temperament score is positively associated with systolic blood pressure and in women with the earlier development of hypertension. The background of these associations is probably based on the more prevalent presence of common risk factors (smoking, obesity, alcoholism) with more pronounced cyclothymic temperament. The scientific importance of the research of the associations of personality traits including affective temperaments with somatic disorders can help in the identification of higher risk patient subgroups.]

Clinical Neuroscience

Cholinesterase inhibitors and memantine for the treatment of Alzheimer and non-Alzheimer dementias


In aging societies, the morbidity and mortality of dementia is increasing at a significant rate, thereby imposing burden on healthcare, economy and the society as well. Patients’ and caregivers’ quality of life and life expectancy are greatly determined by the early diagnosis and the initiation of available symptomatic treatments. Cholinesterase inhibitors and memantine have been the cornerstones of Alzheimer’s therapy for approximately two decades and over the years, more and more experience has been gained on their use in non-Alzheimer’s dementias too. The aim of our work was to provide a comprehensive summary about the use of cholinesterase inhibitors and memantine for the treatment of Alzheimer’s and non-Alzheimers’s dementias.