Lege Artis Medicinae

[Oscar knows but won't say...]

NAGY András László

AUGUST 31, 1994

Lege Artis Medicinae - 1994;4(08)

[With a lucky hand, the organisers have set the season-closing LAM Club meeting on a juicy date. The invitation announced that the future Minister of Welfare would be among the guests. Not only was he present, but, as we shall see, so were the most important personalities shaping health policy in the near future. On this day - the day of the signing of the coalition agreement between the MSZP and the SZDSZ - everyone knew exactly who would be assigned to what function, and they asked and answered questions with this in mind, but the host, the invited MP and the members of the very distinguished group of guests accepted as a tacit rule that they knew what they knew, but they would not say. As a result, we were able to participate in a good-humoured, genuinely friendly meeting, not lacking in declarations, without any circle of honour, but with responsible words and then accountable statements.]



Further articles in this publication

Lege Artis Medicinae

[The role of baseline duplex sonographic examination in monitoring the transplanted kidney in the early postoperative period]


[Routine baseline duplex sonography and sonographic monitoring have been performed afer kidney transplantation at our University since November, 1992. Data on 24 patients are analysed. Baseline sonograms were assessed as normal in 18 patients. Abnormalities involved collecting system dilatation, and swelling of the parenchyma. In every case in which the transplanted kidney had to be removed because of serious complications, we observed morphological changes in the follow-up examination. The resistance index (ARI) measured during duplex Doppler examinations was higher than 75% in 8 of the 24 cases. Four of these grafts had to be removed. From among the 16 cases having normal baseline RI, only 2 kidneys were lost during the postoperative period. Baseline and follow-up duplex sonographic examinations were found to have an important role in the management of kidney transplanted patients. Early complications can be detected, therapy can be initiated in time, and the changes occurring during follow-up can be evaluated more sensitively. ]

Lege Artis Medicinae

[Catheter ablation of supraventricular tachycardias]


[Medical therapy for supraventricular arrhythmias is often ineffective. Arrhythmia surgery is limited by its considerable morbidity and cost. A better understanding of the exact anatomic-electrophysiologic correlations that govern supraventricular arrhythmogenesis and the advances in catheter ablative techniques have led to a new, effectual and costeffective therapy. Catheter ablation techniques result in a high rate of success rates and a low rate of complications. Radiofrequency ablation has become an accepted form of treatment for a variety of supraventricular arrhythmias. This review summarizes current data on catheter ablation of supraventricular arrhythmias.]

Lege Artis Medicinae

[The role of langerhans' cells in the development of cervical cancer]

PETE Imre, SÁPI Sándor, GONDA Gábor

[While the number of deaths from cervical cancer of women over the age of 45, has fallen in the recent years the mortality in women under the age of 35 has increased. The reason for this change is not clear. A large number of analytical studies tried to identify the risk factors for cervical cancer (age, marital status, time of first intercourse, number of sexual partners, coital frequencies, circumcision of partners, menstrual patterns, gravidity, type of contraception, smoking, viral infection, socioeconomic circumstances) but the real con nection between the disease and the varions risk factors remained unclear. The results of these studies suggest that, the 'one hit one tumor' hypothesis can't be proven, and it seems more appropriate to cousider a complex effect of these etiologic factors acting on the altered immunologic status of the cervix uteri. We tried to concentrate on one out of these factors from the literature which may play a cardinal role in the development of CIN or invasive cervix cancer. It is evident from the literature that the macrophages present in the cervix tissue in CIN, or infiltrating the tumor tissue in invasive cancer, could influence either the development of cervical cancer or the prognosis of the disease. It has long been known that in the cervical tissue there are a specific type of dentric cells taking part in the antigen presentation process. The examination of behavior, distribution and activity of these so – called Langerhans cells due to the exogen effect in the cervical tissue may be a which contributes to the understanding of the process leading to the development of CIN. ]

Lege Artis Medicinae

[Morbidity of ischemic heart disease in early breast cancer patients 15-20 years after adjuvant radiotherapy]


[Our aim was to assess the frequency of cardiac side effects, primarily ischemic heart disease, in symptom-free patients with early breast cancer previously treated with radio therapy. Thirty-seven survivors of a previous randomized study of early breast cancer were examined. Twenty patients irradiated pre- or postoperatively for left-sided disease (study group patients) were compared with 17 controls who were either treated for right-sided disease, or were non-irradiated patients. Radiotherapy was randomized in the original study; either tangential field Co-, or electron-therapy was delivered. A bicycle ergometry stress test with 99m Tc Sesta MIBI myocardial perfusion scintigraphy was carried out and the patients' major risk factors for ischemic heart disease were also listed. Our results showed a significant difference between the scintigraphic findings of the two groups. Five of the 20 study group patients (25%), and none of the 17 controls exhibited some kind of significant defect on scintigraphy, indicating ischemic heart disease (p <0,05). Radiotherapy for left-sided breast cancer with the above-mentioned treatment technique may be an independent risk factor in the long-term development of ischemic heart disease. The need to optimize adjuvant radiotherapy for early breast cancer by considering the dose both to the heart as well as the cancer, is emphasized. ]

Lege Artis Medicinae

[Recovery from persistent vegetative state of four months or more]

KEITH Andrews

[A retrospective study was carried out on 43 patients admitted to a ward specifically designed for the rehabilitation of patients with persistent vegetative states after another. Of these, 11 regained consciousness four months or more after brain injury. It was reported that the patients' first reaction to being able to follow with their eyes was between the 4th month and the 3rd year of the condition, while the first reaction to being instructed was between the 4th and the 12th month. Only one patient was unable to communicate, six used non-verbal means to express at least yes and no, four could speak. Six patients required full care, while two became independent in their daily activities. Four patients were able to eat independently, three needed assistance, and four patients required maintenance of gastric tube feeding.]

All articles in the issue

Related contents

Clinical Neuroscience

[The role of sleep in the relational memory processes ]

CSÁBI Eszter, ZÁMBÓ Ágnes, PROKECZ Lídia

[A growing body of evidence suggests that sleep plays an essential role in the consolidation of different memory systems, but less is known about the beneficial effect of sleep on relational memory processes and the recognition of emotional facial expressions, however, it is a fundamental cognitive skill in human everyday life. Thus, the study aims to investigate the effect of timing of learning and the role of sleep in relational memory processes. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. Our results suggest that the timing of learning and sleep plays an important role in the stabilizing process of memory representation to resist against forgetting.]

Clinical Neuroscience

[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

[Risk of nonsteroidal antiinflammatory drugs. Focus on aceclofenac]


[Nonsteroidal antiinflammatory drugs (NSAIDs) are among the most frequently used pharmaceuticals. Nevertheless, a number of studies emphasized that NSAIDs were damaging not only the gastrointestinal (GI), but also the cardiovascular (CV) system, could increase the blood pressure, the frequency of coronary events (angina, myocardial infarction) and stroke incidence, as well as they might deterio­rate renal functions. The National Institute for Health and Care Excellence (NICE) did not find evidence that administering NSAIDs could increase the risk of developing COVID-19 or worsened the condition of COVID-19 patients. However, unwanted effects of specific drugs differ substantially in their occurrence and seriousness as well. It seemed to be for a long time that the NSAIDs provoked higher GI-risk was closely related to the COX1/COX2 selectivity, like the cardiovascular (CV) risk to the COX2/COX1 selectivity, however, the recent data did not prove it clearly. Based on the available literature while pondering the gastrointestinal and cardiovascular adverse events, among all NSAIDs the aceclofenac profile seemed to be the most favourable.]

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. ]

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.]