Lege Artis Medicinae

[Report on gastroenterological endoscopic activity in Hungary in 1989]

NAGY György1, JUHÁSZ László1

FEBRUARY 09, 1991

Lege Artis Medicinae - 1991;1(03)

[The Endoscopic Section of the Hungarian Gastroenterological Society, under the leadership of Professor Wittmann, published an annual report on the status and development of endoscopy of the digestive organs in Hungary from 1975. In 1976, the report reported 27453 examinations performed at 75 endoscopic workplaces with 163 instruments. The 1987 survey already included 139496 examinations (36623 in Budapest, 102873 in the countryside) performed at 117 workplaces (37 in Budapest, 80 in the countryside) with 565 instruments (219 in Budapest, 346 in the countryside). In a statistical summary of 13 years, 968090 endoscopic examinations resulted in 389 (0.4 per thousand) complications, of which 71 (7 per 100,000) were fatal. The collection of study data was interrupted with the death of Professor Wittmann. ]


  1. Borsod-Abaúj-Zemplén-megyei Kórház, Miskolc II. Belgyógyászati Osztály



Further articles in this publication

Lege Artis Medicinae

[The role of computer tomography and magnetic resonance imaging in organic neurological diagnosis]

KENÉZ József

[In the last two decades, neuroimaging became the basic investigative method in the diagnostics of organic neurology due to the rapid development of medical electronics. In the nineties called the "Decade of the Brain", the importance of these methods could hardly bee overestimated. The two outstanding investigations of neuroimaging are computer tomography (CT) and magnetic resonance imaging (MR). Surely in the near future the application of these investigations will be incorporated in the Hungarian healthcare system as well. In this review all the points of view are collected on the basis of neurologic clinical symptomatology to help clinicians to decide, which method and when has to be chosen to gain the most valuable and detailed information on the quickest way, with less risk, and for the least amount of money ]

Lege Artis Medicinae

[Awareness of hypoglycaemia in diabetes mellitus: Prospective clinical-epidemiological investigations]


[In order to survey the frequency of hypoglycaemia and its awareness we investigated 91 insulin- treated diabetic women (48 pregnant and 43 non-pregnant) consecutively using 9 to 15 blood glucose measurements. Subjective hypoglycaemic symptoms of patients were registered by using a structured questionnaire. Biochemically proved hypoglycaemia has been found in two third of patients (62/91). One third of the patients had a loss of awareness, 23 had partial awareness and 19 were aware of hypoglycaemia. No significant difference were found according to age, diabetes duration, daily insulin dose/kg body weight, glycated haemoglobin levels and frequency of diabetic complications. Five standard cardiovascular autonomic reflex-tests were performed in 31 patients. Age, diabetes duration, frequency of diabetic complications of patients with evidence of autonomic neuropathy significantly surpassed that of having normal cardiovascular reflex-tests. Our results confirm from clinical-epidemiological aspect that hypoglycaemia unawareness is not invariably associated with cardiovascular autonomic neuropathy. ]

Lege Artis Medicinae

[Five cases of operated atrial tumors]


[Between November 1986. and June 1989. five patients underwent excision of an atrial tumour. Two of the patients had previous peripheral embolization, two had cardiac symptoms and one was symptomless. All the tumours were demonstrated by means of echocardiography and in four cases by angiocardiography as well. Four of them were left atrial tumors and one in the right atrium. The tumors were succesfully removed in all patients: in three cases by shaving them from the endocardium, in one case by excising a portion of atrial septum and in one case with a margin of normal atrial wall. Histological examination showed thrombus in one case. All patients survived operation and left hospital in good conditions. During the follow up there were no cardiac complication or local recurrence.]

Lege Artis Medicinae

[Hypothesis of natural birth]


[It's supposed by the author that there exists a natural birth. According to his assumption in every woman's subconscionsness there is the code of the natural birth's behaviour (CODE), which can be spontaneously mobilized in the gravid woman. Putting into practice whichever way for the preparation of the birth, this mobilization can be advanced and in this way the child-bearing women's behaving repertory during their birth is increasing and it's drawing near to the equivalent of its own code. This may be the explication of the success and result of the alternative obstetrics end the preparing programs for the different births. The psychological explanation of the theory is given on the basis of C. G. Jung's activity.]

Lege Artis Medicinae

[Brief News]

[High-resolution magnetic resonance imaging of skull base vascular lesions summary study; PET, CT and MR in the differential diagnosis of neuropsychiatric diseases today's applications; Infectious diseases of the brain]

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Clinical Neuroscience

Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.

Clinical Neuroscience

[The connection between the socioeconomic status and stroke in Budapest]


[The well-known gap bet­ween stroke mortality of Eastern and Western Euro­pean countries may reflect the effect of socioeconomic diffe­rences. Such a gap may be present between neighborhoods of different wealth within one city. We set forth to compare age distribution, incidence, case fatality, mortality, and risk factor profile of stroke patients of the poorest (District 8) and wealthiest (District 12) districts of Budapest. We synthesize the results of our former comparative epidemiological investigations focusing on the association of socioeconomic background and features of stroke in two districts of the capital city of Hungary. The “Budapest District 8–12 project” pointed out the younger age of stroke patients of the poorer district, and established that the prevalence of smoking, alcohol-consumption, and untreated hypertension is also higher in District 8. The “Six Years in Two Districts” project involving 4779 patients with a 10-year follow-up revealed higher incidence, case fatality and mortality of stroke in the less wealthy district. The younger patients of the poorer region show higher risk-factor prevalence, die younger and their fatality grows faster during long-term follow-up. The higher prevalence of risk factors and the higher fatality of the younger age groups in the socioeconomically deprived district reflect the higher vulnerability of the population in District 8. The missing link between poverty and stroke outcome seems to be lifestyle risk-factors and lack of adherence to primary preventive efforts. Public health campaigns on stroke prevention should focus on the young generation of socioeconomi­cally deprived neighborhoods. ]

Clinical Neuroscience

[The Comprehensive Aphasia Test in Hungarian]


[In this paper we present the Comprehensive Aphasia Test-Hungarian (CAT-H; Zakariás and Lukács, in preparation), an assessment tool newly adapted to Hungarian, currently under standardisation. The test is suitable for the assessment of an acquired language disorder, post-stroke aphasia. The aims of this paper are to present 1) the main characteristics of the test, its areas of application, and the process of the Hungarian adaptation and standardisation, 2) the first results from a sample of Hungarian people with aphasia and healthy controls. Ninety-nine people with aphasia, mostly with unilateral, left hemisphere stroke, and 19 neurologically intact control participants were administered the CAT-H. In addition, we developed a questionnaire assessing demographic and clinical information. The CAT-H consists of two parts, a Cognitive Screening Test and a Language Test. People with aphasia performed significantly worse than the control group in all language and almost all cognitive subtests of the CAT-H. Consistent with our expectations, the control group performed close to ceiling in all subtests, whereas people with aphasia exhibited great individual variability both in the language and the cognitive subtests. In addition, we found that age, time post-onset, and type of stroke were associated with cognitive and linguistic abilities measured by the CAT-H. Our results and our experiences clearly show that the CAT-H provides a comprehensive profile of a person’s impaired and intact language abilities and can be used to monitor language recovery as well as to screen for basic cognitive deficits in aphasia. We hope that the CAT-H will be a unique resource for rehabilitation professionals and aphasia researchers in aphasia assessment and diagnostics in Hungary. ]

Clinical Neuroscience

Comparison of direct costs of percutaneous full-endoscopic interlaminar lumbar discectomy and microdiscectomy: Results from Turkey

ÜNSAL Ünlü Ülkün, ŞENTÜRK Salim

Microdiscectomy (MD) is a stan­dard technique for the surgical treatment of lumbar disc herniation (LDH). Uniportal percutaneous full-endoscopic in­terlaminar lumbar discectomy (PELD) is another surgical op­tion that has become popular owing to reports of shorter hos­pitalization and earlier functional recovery. There are very few articles analyzing the total costs of these two techniques. The purpose of this study was to compare total hospital costs among microdiscectomy (MD) and uniportal percutaneous full-endoscopic interlaminar lumbar discectomy (PELD). Forty patients aged between 22-70 years who underwent PELD or MD with different anesthesia techniques were divided into four groups: (i) PELD-local anesthesia (PELD-Local) (n=10), (ii) PELD-general anesthesia (PELD-General) (n=10), (iii) MD-spinal anesthesia (MD-Spinal) (n=10), (iv) MD-general anesthesia (MD-General) (n=10). Health care costs were defined as the sum of direct costs. Data were then analyzed based on anesthetic modality to produce a direct cost evaluation. Direct costs were compared statistically between MD and PELD groups. The sum of total costs was $1,249.50 in the PELD-Local group, $1,741.50 in the PELD-General group, $2,015.60 in the MD-Spinal group, and $2,348.70 in the MD-General group. The sum of total costs was higher in the MD-Spinal and MD-General groups than in the PELD-Local and PELD-General groups. The costs of surgical operation, surgical equipment, anesthesia (anesthetist’s costs), hospital stay, anesthetic drugs and materials, laboratory wor­kup, nur­sing care, and postoperative me­dication diffe­red significantly among the two main groups (PELD-MD) (p<0.01). This study demonstrated that PELD is less costly than MD.

Lege Artis Medicinae

[History of vaccine production in Hungary ]


[This study presents the complete history of the Hungarian vaccine production, partly in association with the process of fighting vaccine-preventable infectious diseases, and underlines the fact that every government actively contributed to the age-adjusted mandatory vaccination schedule of the past 140 years. It demonstrates the various achievements from the smallpox lymph production through the launch of diphtheria serum production at Phylaxia and the establishment of the National Public Health Institute (OKI) with its vaccine production and the later institutional transformation of OKI into Humán as economic corporation to its closure. Among all OKI’s vaccine production activities, this study focuses on the production of influenza vaccines, due to its international importance in the 1960s and 1970s. The vaccine production against diphtheria tetanus and pertussis stands out from Humán’s activities, and the tetanus component of this vaccine is still used in the products of a multinational vaccine manufacturer. ]