Lege Artis Medicinae

[Regime change?]

MAY 29, 1991

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

[Finally, the first law of the comprehensive reform of the health care system, the Law on Public Health and Medical Services, has just been passed! Live long and fulfill the hopes of its creators! There must be tens of millions of us for whom this is a vital necessity.]

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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. ]

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[Diagnosis and treatment of neck pain]

BÁLINT Géza, SZEBENYI Béla, BÁLINT Péter

[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]

BITTERA István, GYURKOVITS Kálmán

[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]

DEUTSCH Tibor, WÁGNER János, TAMÁS Gyula

[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.]

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[A short chronicle of three decades ]

KAPRONCZAY Katalin

[Hungarian professional periodicals started quite late in European context. Their publish­ing, editing and editorial philosophy were equally influenced by specific historical and political situations. Certain breaking points of history resulted in termina­tion of professional journals (War of In­de­pendence 1848-1849, First and Se­cond World Wars), however there were pe­riods, which instigated the progress of sciences and founding of new scientific journals. Both trends were apparent in years after the fall of former Hungarian regime in 1990. The structure of book and journal publishing has changed substantially, some publishers fell “victim” others started successfully as well. The latters include the then-established publishing house Literatura Medica and its own scientific journal, Lege Artis Me­di­cinae (according to its subtitle: New Hun­garian Medical Herald) issued first in 1990. Its appearance enhanced significantly the medical press market. Its scientific publications compete with articles of the well-established domestic medical journals however its philosophy set brand-new trends on the market. Concerning the medical community, it takes on its problems and provides a forum for them. These problems are emerging questions in health care, economy and prevention, in close interrelation with system of public health institutions, infrastructure and situation of those providing individual health services. In all of them, Lege Artis Medicinae follows consequently the ideas of traditional social medicine.]

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Lege Artis Medicinae

[Current issues in the peripartum management of diabetic women from the perspective of an internist-diabetologist]

KERÉNYI Zsuzsanna

[In pregnancy complicated with diabetes, treatment of hyperglycaemia is of fundamental importance during delivery in order to improve the outcome parameters of both the mother and the neonate. This is particularly important in the case of mothers with type 1 diabetes and of all mothers who require insulin treatment during their pregnancy. The use of antenatal steroids for women at risk of pre-term birth further complicates the treatment of hyperglycaemia in the period immediately before delivery and requires the appropriate change of insulin therapy. The requirement of nil per os in the delivery period necessitates proper fluid, glucose and insulin treatment in the pre-delivery hours. After surgical delivery the patients may also need infusion treatment until the first meal. As there is no unified guideline for the peripartum management of diabetes, the author re­views the international literature on the internal medicine issues concerning the peripartum treatment of pregnant women with diabetes. This study reviews the characteristics of insulin treatment of women with various types of diabetes before, du­ring and di­rect­ly after delivery. It presents a dosing schedule for women who needed an antenatal steroid treatment in the period before delivery due to premature birth for the purpose of lung maturation. The study also addresses the application and programming of pe­ripartum blood glucose tests, continuous interstitial glucose monitoring (CGM) and insulin pump treatment (CSII).]

Clinical Neuroscience

[Consensus statement of the Hungarian Clinical Neurogenic Society about the therapy of adult SMA patients]

BOCZÁN Judit, KLIVÉNYI Péter, KÁLMÁN Bernadette, SZÉLL Márta, KARCAGI Veronika, ZÁDORI Dénes, MOLNÁR Mária Judit

[Background – Spinal muscular atrophy (SMA) is an autosomal recessive, progressive neuromuscular disorder resulting in a loss of lower motoneurons. Recently, new disease-modifying treatments (two drugs for splicing modification of SMN2 and one for SMN1 gene replacement) have become available. Purpose – The new drugs change the progression of SMA with neonatal and childhood onset. Increasing amount of data are available about the effects of these drugs in adult patients with SMA. In this article, we summarize the available data of new SMA therapies in adult patients. Methods – Members of the Executive Committee of the Hungarian Clinical Neurogenetic Society surveyed the literature for palliative treatments, randomized controlled trials, and retrospective and prospective studies using disease modifying therapies in adult patients with SMA. Patients – We evaluated the outcomes of studies focused on treatments of adult patients mainly with SMA II and III. In this paper, we present our consensus statement in nine points covering palliative care, technical, medical and safety considerations, patient selection, and long-term monitoring of adult patients with SMA. This consensus statement aims to support the most efficient management of adult patients with SMA, and provides information about treatment efficacy and safety to be considered during personalized therapy. It also highlights open questions needed to be answered in future. Using this recommendation in clinical practice can result in optimization of therapy.]

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[Neuropsychological rehabilitation following acquired brain injury]

TAMÁS Viktória, KOVÁCS Noémi, TASNÁDI Emese

[Neuropsychological rehabilitation or rehabilitation neuropsychology is a field within applied neuropsychology. It originally diverges from applied clinical and functional neuropsychology, although it could not be entirely differed from them. The unique nature of this area over the complexity is given by its process-controlled and system-approach aspects. In Hungary the number of neurorehabilitation centres and departments requiring neurocognitive rehabilitation has been continually increasing. Nevertheless, the number is still low; accordingly in our country this field is relatively young and isn’t well known. Authors of this review would like to draw attention to the importance of rehabilitation of patients with acquired brain injury and improvement of their quality of life with the theoretical and practical knowledge, as well as the necessity of future alterations and challenges emphasizing the need of a significant change of this narrow domain. ]