Lege Artis Medicinae

[Some data on the GP business, a quarter after the introduction of the new financing scheme]

BALOGH Sándor

NOVEMBER 30, 1993

Lege Artis Medicinae - 1993;3(11)

[Since April 1992, it has been legally and financially possible to operate the GP services that replaced the former district medical services, either as a business or as a private practice. Also since then, it has been possible to do this without a territorial commitment or by entering into a territorial commitment, i.e. by taking over the old district in the old sense, by agreement with the municipality. ]

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Lege Artis Medicinae

[Management of extremity injuries in mass catastrophes]

CZIFFER Endre

[The author details the characteristics of the management of extremity injuries in extreme conditions and describes the significant differences of injury management between extreme and peacetime circumstances. The theme is of great significance these days, owing to the rapidly rising frequency of military and civilian mass casualties and the parity of extremity injuries that reach up to 60%. The ideal devices, mental approach and organizational reflexes also differ from the traditional surgical routine to achieve an effective health service in catastrophe. Therefore preparation and training must be done in peacetime. The role of intuitions, improvisation and flexibility is very important, because there have not been two similar catastrophe situations yet and compromising management replaces the routine medical care. For fracture management special external fixators are preferable that have been developed and deviced for war injuries and that respect the budgetary and logistic aspects of catastrophe management.]

Lege Artis Medicinae

[Application of cytokine therapy in haematological diseases]

PÁLÓCZI Katalin, PETRÁNYI Győző

[The clinical applications of cytokines playing a role in regulation of haematopoesis are summarized. The potential clinical use of human cytokines can arbitrarily be ramified into 4 strategies: 1. Stimulation of the immune response in order to enhance immunosurveillance of neoplasms. 2. Prevention of chemotherapy and tumour related immuno- and myelosuppression and improvement of non-specific mechanisms of host resistance. 3. Increase of maximum tolerated doses of conventional antitumour chemotherapeutic regimens. 4. Direct influence on tumour cell growth and differentiation via cytotoxic, cytostatic or regulatory mechanisms. Three interferons, almost 6 different interleukins, erythropoetin and three different colony stimulating factors are presented. The potential benefits of cytokines in haematological malignancies and also the difficulties in realising this potential are discussed. ]

Lege Artis Medicinae

[Natural alfa interferon in the treatment of oral viral and virus associated diseases]

KÖVESI György, ONÓDY Klára, PÁLÓCZY Katalin, FEKETE Béla

[A native natural alfa interferon was applied in the treatment of 35 patients. The patients were suffering from oral virus infections (herpetic gingi vostomatitis, recurrent herpetic infections) and viral associated diseases (herpetic ulceration, recurrent aphthous ulcer, Sutton aphthous ulcer and postherpetic exudative erythaema). The patients received 1 or 2 million IU of alfa interferon im. daily for ten days. Laboratory investigations were carried out before and 10 days after the treatment. In addition to routine laboratory tests, we counted the number of absolute lymphocytes, LGL cells and immediate and late SRBC rosettes. In ten cases we noted the changes of the following surface markers: CD 2, CD 3, CD 4, CD 8, CD 11b, CD 14, CD 20, CD 25, CD 45, CD 45R and HLA-DR. There were no significant differences in the routine laboratory parameters before and after the treatment, whereas there were statistically significant increases in the number of LGL cells and in the count immediate and late rosettes. A significant increase in the expression of CD 8, CD 11b, CD 14, CD 25, and CD 45R also occurred. There were no adverse side effects interrupting the treatment. Alfa interferon seems to be useful in the treatment of these oral diseases. ]

Lege Artis Medicinae

[The role of ultrasonography in the detection of hip joint pseudoarthrosis infection]

FÖLDES Károly, BÁLINT Péter, LAKATOS Tamás, BÁLINT Géza

[In the background of rest pain in pseudoarthrosis of the hip there may be synovitis of the pseudojoint, which can be infected as well. The author's aim was to examine what sort of help ultrasound can provide in clearing of the cause of rest pain occuring in pseudoarthrosis besides the other classical imaging methods. 14 patients undergone resection arthroplasty of the hip complaining of rest pain and 12 control subjects were examined. All of them had pelvic X ray and ultrasound examination of the pseudojoint. In two cases primer, in 24 cases secunder pseudoarthrosis had been formed. In the patient group with rest pain in 12 cases synovitis was detected by ultrasound and in 2 cases of the control group. Aspiration of the pseudo arthrosis was performed in 12 cases and in 8 of them synovial fluid was obtained. Two of them were infected originally. Synovitis was proved by arthrography in 4 cases. Ultrasound can help in the detection of synovitis of pseudojoint in patients under gone resection arthroplasty and therefore can help in making diagnosis of the infection and making decision of the therapeutic approach. ]

Lege Artis Medicinae

[Randomised Intervention Treatment of Angina trial]

MATOS Lajos

[There were 16 deaths in the PTCA group and 18 in the CABG group. There was already a difference in the incidence of myocardial infarction between the two regimens (PTCA: 33, CABG: 20), but this was not statistically significant. 4% of those treated with PTCA required an emergency repeat of the procedure and a further 15% required CABG surgery during follow-up. Within two years, 38% of those treated with PTCA and 11% of those operated on required revascularisation. Coronary angiography had to be repeated four times more often in patients in the PTCA group than in those in the CABG group (31% versus 7%, p<0.001). Angina was also more common six months after PTCA (32%) than after surgery (11%), and those treated with dilatation were taking more antianginal drugs. One month after CABG, however, patients' physical workload was lower than after PTCA, although this difference disappeared later. Patients needed longer rehabilitation time after surgery than after PTCA, but those who underwent surgery had significantly less angina within two years and were less likely to need further diagnostic or therapeutic intervention.]

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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.

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

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[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.]