Lege Artis Medicinae

[On amortisation - finally getting serious]


MARCH 31, 1993

Lege Artis Medicinae - 1993;3(03)

[For two years now, we have been hearing from doctors, investors, ministers, state secretaries, insurance experts and OTF officials who want to do business that "entrepreneurial health care" will remain an empty slogan as long as social security is not capable of sector-neutral financing, as long as it does not take amortization into account when setting prices, which do not even exist today (let alone interest on invested capital). Seeing that there is once again no attempt to solve the problem in the bill on the financial basis of social security and its 1993 budget, the Free Democrat MEP Csaba Fáklya has thrown a stone into the water.]



Further articles in this publication

Lege Artis Medicinae

[Epidemiology of breast cancer]


[In 1987 breast cancer occupied the 3rd place among female cancers in the world. In Hungary, 13.577 women died due to cancer in 1990, 15,4% from breast cancer. The author uses international, and Hungarian data (at the country and county level) and also the data from his own research results. Incidence of breast cancer has risen continuously and shows a wide range in different parts of the world from 14,1 %000/year to 121,2%8000/year. The 5 year crude survival rate is between 40–65% and is slowly improving. In addition to the well-known risk-factors, the author emphasizes the role of mastopathy because in his patient group of 843 cases 2,3%, but in the mastopathy group 4,1% developed cancer. Therefore, this alteration should be considered as a high risk factor. Among close female relatives of breast cancer patients breast and other cancer has occurred much more frequently, than in that of a control group. Prostate cancer occurs significantly more frequently among 1 st degree male relatives. Therefore it is necessary to study the risk factors with epidemiologic methods and to broaden screening, detection and therapy in order to reduce the incidence and mortality of breast cancer. ]

Lege Artis Medicinae

[Brest cancer screening, early diagnosis]


[There is no data in the medical literature concerning the late results of breast physical exam by paramedical personnel as a screening test. In a population screening for breast cancer in Debrecen, nearly 70 thousand women were observed from 1981 to 1985 and 298 new breast cancer patients were detected. 198 patients were from the screened population and 100 patients from the non screened population. All of the breast cancer patients were followed up, and the analysis was completed on 31st December 1991 with the help of statistical methods. The author analysed the overall survival, cumulative death rate and relative risk of dying according to age group. The difference of overall survival was 29% for the screened group. This result is nearly the same as that produced by mammographic screening.]

Lege Artis Medicinae

[Diagnostics of breast cancer]


[The author interpretes and evaluates the diagnostic methods of breast cancer. Detailed description is given on physical examination, mammography, ultrasound examination, cytology, histology and miscellaneous methods, expressing their advantages and drawbacks. On clinical experience nowadays the combinative application of these by the same expert seems to be the most effective method, possibly in large breast clinic centres.]

Lege Artis Medicinae

[Breast cancer markers of prognostic significance]

TÓTH József, SÁPI Zoltán

[Prognosis prediction of breast cancers is difficult, particularly in early clinical stage (1) or in tumors with practically identical histological structure and degree of differentiation (invasive ductal NOS cancer) because node negative tumors of early developmental stage or with identical structure may demonstrate different clinical course. In such cases the steroid hormone receptor content, the prolife rating capacity of the tumor and the so called independent prognostic factors like the onco gene and supressor gene expression (c-myc, C-erbB–2, p53), the growth factor receptor content (EGFr) and the so called differentiation antigens accompanied by low metastatising capacity (MAM–6, nm23) may help the pathologist in diagnostics. Examinations of these markers are planned to be introduced in future diagnostics and contribute to the elaboration of effective treatment schedules.]

Lege Artis Medicinae

[The surgery of breast cancer]


[The incidence of breast cancer in Hungary is gradually increasing, not only in the elderly due to the increasing average age, but in younger women as well. In the operative stadia (St I-II), the best results can be achieved by a radical surgical intervention and an adjuvant radio-chemo-hormone therapy. The formerly routine radical mastectomies are being replaced by breast conserving procedures which remove the tumour and sacrife only the most necessary surrounding tissues to achieve the best local tumour control. The fundamental basis for this procedure was established by the clinical trials of B. Fisher and U. Veronesi. The practical basis is the circumstance, that owing to better propaganda, more frequent breast self examinations, and better mammographic and cytological facilities, more breast cancer will be recognized in an earlier stage.]

All articles in the issue

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Lege Artis Medicinae

[Vaccines against COVID-19 pandemic]


[The rapidly spreading SARS-CoV2 respiratory virus has evoked an epidemic with serious aftermath around the world. In addition to the health effects, the global economic damage is actually unpredictable. At the same time, the pandemic has launched a series of unprecedented collaborative scientific research, including the development of vaccines. This study summarizes up-to-date information on vaccines, immune memory, and some emerging clinical effects.]

Journal of Nursing Theory and Practice

[Non-pharmacological prevention and treatment for postoperative delirium in elderly patients with hip fracture - a systematic review]

VIDA Nóra, PAPP László

[Delirium is defined as a disturbance of consciousness and cognition that develops over a short period of time and fluctuates over time. During the last decade, the number of publications dealing with different aspects of delirium have been grown. The key points in most articles are pharmacological prevention and treatment, but because the rise of health care expenditures, all activities, which cost-effectively support the care process, is getting more and more important. The aim of the study: The aim of this research is to review the non-pharmacological prevention and treatment possibilities of delirium in elderly patients undergoing hip surgery. Systematic review, using articles published between 1999 and 2019 in PubMed and Wiley Online Libraries. Non-pharmacologic treatments significantly reduced the incidence (p=0.003–0.045) and duration (p=0.009–0.03) of delirium. The interventions also contributed to decrease the number of episodes (p=0.03), and to make the symptoms lighter. Early mobilisation and adequate fluid and electrolyte intake are key factors in reducing the incidence of delirium. Measuring oxygen saturation and support, appropriate nutrition, effective pain treatment, minimizing drug-interactions, maintaining good sleep and managing sensory dysfunctions have an effect on incidence, duration and severity of delirium.]

Clinical Neuroscience

A variant of Guillain-Barre syndrome after SARS-CoV-2 vaccination: AMSAN

TUTAR Kaya Nurhan, EYIGÜRBÜZ Tuğba, YILDIRIM Zerrin, KALE Nilufer

Introduction - Coronavirus disease 2019 (COVID-19) is a respiratory infection that has rapidly become a global pandemic and vaccines against SARS-CoV-2 have been developed with great success. In this article, we would like to present a patient who developed Guillain-Barré syndrome (GBS), which is a serious complication after receiving the inactive SARS-CoV-2 vaccine (CoronaVac). Case report – A 76-year-old male patient presented to the emergency department with nine days of progressive limb weakness. Two weeks prior to admission, he received the second dose of CoronaVac vaccine. Motor examination revealed decreased extremity strength with 3/5 in the lower extremities versus 4/5 in the upper extremities. Deep tendon reflexes were absent in all four extremities. Nerve conduction studies showed predominantly reduced amplitude in both motor and sensory nerves, consistent with AMSAN (acute motor and sensory axonal neuropathy). Conclusion - Clinicians should be aware of the neuro­logical complications or other side effects associated with COVID-19 vaccination so that early treatment can be an option.

Clinical Neuroscience

[Dysphagiafelmérések akut stroke-ban]

SZABÓ Pál Tamás, MÛHELYI Viktória, BÉRES-MOLNÁR Katalin Anna, KOVÁCS Andrea, BALOGH Zoltán, FOLYOVICH András

[Stroke associated dysphagia can have serious consequences such as aspiration pneumonia. The Hungarian guideline on nutritional therapy for stroke patients recommends dysphagia assessment, as early screening can optimize disease outcome and hospital cost. Thus far, this may be the first study in Hungarian that has documented a systematic review about the available validated dysphagia assessments of acute stroke. Purpose – The aim of this study was to summarize the instrumentally validated bedside dysphagia screening tools for acute stroke patients, which were published in the last twenty years. Our objective was to describe the characteristics of the validation studies, examine their study design, and sample the sub-tests and the diagnostic accuracy of the assessments. A systematic research was carried out of the literature between 2001 and 2021 in eight scientific databases with search terms appropriate to our objectives. Subjects of the study – 652 articles were found and were reduced to eight. We made a comparative analysis of these. The GUSS test reached a high level of sensitivity compared to the others. In our study sample, the prevalence of instrumentally confirmed dysphagia among acute stroke patients was 56.1%. The focus and the composition of the analyzed studies differed and posed problems such as the ambiguity of the concept of dysphagia, the difference in outcome indicators, or the timing of screening. The GUSS test, which offers domestic management, is a suitable tool for the Hungarian clinical use.]

Clinical Neuroscience

Neurological disorders in liver transplantation

YUKSEL Hatice , AYDIN Osman, ARI Derya , OTER Volkan , AKDOGAN Meral , BIROL BOSTANCI Erdal

Liver transplantation is the only curative treatment in patients with end-stage liver failure. It has been associated with neurological disorders more frequently than other solid organ transplantations. We aimed to detect neurological disorders in liver transplantation patients and determine those that affect mortality. One hundred eighty-five patients, 105 with and 80 without neurological disorders, were included in this study. The follow-up was categorized into three periods: preoperative, early postoperative and late postoperative. We analyzed all medical records, including demographic, laboratory, radiological, and clinical data. Neurological disorders were observed in 52 (28.1%) patients in the preoperative period, in 45 (24.3%) in the early postoperative, and in 42 (22.7%) in the late postoperative period. Hepatic encephalopathy in the preoperative and altered mental state in the post­operative period were the most common neurological disorders. Both hepatic encephalopathy (37.5%) and altered mental state (57.7%) caused high mortality (p=0.019 and 0.001) and were determined as indepen­dent risk factors for mortality. Living donor transplantation caused less frequent mental deterioration (p=0.049). The mortality rate (53.8%) was high in patients with seizures (p=0.019). While mortality was 28.6% in Wilson’s disease patients with neurological disorders, no death was observed in patients without neurological disorders. We identified a wide variety of neurological disorders in liver transplantation patients. We also demonstrated that serious neurological disorders, including hepatic encephalopathy and seizures, are associated with high morbidity and mortality. Therefore, in order to avoid poor outcomes, hepatic encephalopathy should be considered as a prioritization criterion for liver transplantation.