Lege Artis Medicinae

[The advent of the computer in healthcare]

BORDÁS István1

FEBRUARY 26, 1992

Lege Artis Medicinae - 1992;2(02)

[In the following, some characteristics of "online" computer applications are analysed from a sociological perspective. Lonely online tools and the local computer network; The praise of DIY; Issues of distribution and manadgement; Foundation and concept? Observations on a call;]


  1. Az Egészségügyi Informatikai Szakmai Kollégium Elnöke



Further articles in this publication

Lege Artis Medicinae

[New methods of plastic surgery for breast reconstruction]


[The treatment and plastic surgical reconstruction of breast tumour patients raise contradictions and unsolved problems. The approach of breast tumour surgery has been changed recently. New evidence shows that in terms of survival, free from distant disease there is no significant difference between lumpectomy and radical mastectomy. Thus breast-conserving operations as a replacement for radical mastectomy have been spreading. The most characteristic features of these operation are: the horizontal incision, the conservation of the pectoral muscles and the whole or partial preservation of glandular tissues. The quality and quantity of available tissues for the breast reconstruction have changed as, the methods of plastic surgical operations has been adopted. New methods for breast reconstruction such as muscle and musculocutaneous flaps, free flaps, different breast implants, and skin expanders have become more and more preferred. For nipple and areola reconstruction local flaps, skin grafts, external prostheses and tattoo are widely used. Nowadays the most important point of view in there the construction of the breast are accurate symmetry, aesthetic breast form and harmony of the whole body. ]

Lege Artis Medicinae

[Results in the sclerotherapy of varicocele]


[Testicular varicocele which is curable by surgical or transcatheteric methods is one of the most common causes of male infertility. In this study the success of the interventional radiological method was evaluated. Internal spermatic vein phlebographies were performed in the case of left sided varicocele. Before intervention the anamnesis, inspection, palpation, sonography, colour Doppler sonography and phlebography was evaluated and in a part of the cases spermiogramm too. Follow up examinations were performed at 3, 6 and 12 months after the sclerotherapy and the 1.5-4.5 years then later. The internal spermatic vein was succesfully occluded in 2/3 of the patients in the distal third, in 1/3 in the middle or in the upper third. Complications occurred in 10 cases as intima lesions without any consequencies and in 4 patients as scrotal thromboph lebitis. At the follow up examinations very good regression was demonstrated. Persistence or recurrence occured in 5.7% of cases. The spermiogramm usually got back to normal or showed an improvement and we registered 8 pregnancies from 23 formerly infertile marriages. The interventional radiological method is simpler, cheaper, requires shorter time and inpatient period, decreases sick-allowance, and the success rate reaches the level of the surgical method. The joint evaluation of the real time and the colour Doppler ultrasound is a very sensitive method in the interpretation of the results of the treatment. In our opinion sclerotherapy with Varicocid is the method of choice in the treatment of the varicocele. ]

Lege Artis Medicinae

[Mapping of EEG in neurological disorders]


[Mapping is a new way to convey the information of the mathematical analysis of the EEG in an immediately understandable form. In this article, the history of EEG mapping is surveyed. Sixteen channel EEG mapping system was programmed on an IBM-AT personal computer which constructs absolute and relative power spectra topograms on the scalp. Hemispheric asymmetry and long term changes of absolute and relative power estimates were calculated by statistical methods (Wilcoxon and Student t-test). In comparison traditional reading of the EEG the mapping has the following advantages: 1. it uses exact procedures instead of qualitative estimation; 2. in can detect minimal cortical damages; 3. it has the ability to store data for later comparison: the power ratios in selected frequency ranges proved to be a reliable indicator of post-ischemic restitution of EEG; 4. it can evaluate of event related reactions of bioelectric signals in higher resolution. EEG topography provides early information regarding the severity of ischemic lesions in the acute stage of stroke before to the CT scan can visualize the tissue hypodensity. In cases of permanent epileptic waves, the mapping visualizes the local power maxima of dominant frequency ranges and detects the post-ic talimpairment of cortical fields of epileptic foci. Probability significance mapping has reinstated the diagnostic value of EEG by the applica tion of the neuroimaging techniques.]

Lege Artis Medicinae

[Bidirectional Doppler investigation of the internal carotid artery]


[The blood-flow velocity in carodit arteries was measured with a bidirectional CW Kranz bühler 761 Doppler instrument. These investigations were supplemented with special compression tests. 60 investigations were performed to study the blood-flow in the supraorbital and supra trochlear arteries, while compressing the superficial temporal, the facial and the common carotid arteries. The results were compared with 30 regularly performed angiographies. Conclusions: the sensivity of this method is 80%, the specificity is 85%, its positive and negative predictive values are 76% and 87% respectively. Therefore this method is suggested for screening the internal carotid artery. ]

Lege Artis Medicinae

[Ultrasound examination of the knee]


[The knee is frequently injured. In addition to the phisical examination imaging methods are very important in determining the diagnosis of the disorders. Ultrasound method is useful in revealing the injuries of the soft tissues of the knee. The authors examined 350 patients with an Acuson 128 ultrasound machine, using 5 and 7 MHz linear transducer in standard positions. They analized the pathological disorders of the knee joint. They consider the examination of network of the band important. Sonography has a significant role in the diagnosis of knee disorders. That can replace more expensive or invasive examination methods.]

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[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. ]

Clinical Neuroscience

Cholinesterase inhibitors and memantine for the treatment of Alzheimer and non-Alzheimer dementias


In aging societies, the morbidity and mortality of dementia is increasing at a significant rate, thereby imposing burden on healthcare, economy and the society as well. Patients’ and caregivers’ quality of life and life expectancy are greatly determined by the early diagnosis and the initiation of available symptomatic treatments. Cholinesterase inhibitors and memantine have been the cornerstones of Alzheimer’s therapy for approximately two decades and over the years, more and more experience has been gained on their use in non-Alzheimer’s dementias too. The aim of our work was to provide a comprehensive summary about the use of cholinesterase inhibitors and memantine for the treatment of Alzheimer’s and non-Alzheimers’s dementias.

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[Comparative analysis of the full and shortened versions of the Oldenburg Burnout Inventory]

ÁDÁM Szilvia, DOMBRÁDI Viktor, MÉSZÁROS Veronika, BÁNYAI Gábor, NISTOR Anikó, BÍRÓ Klára

[Background – The two free-to-use versions of the Oldenburg Burnout Inventory (OLBI) have been increasingly utilised to assess the prevalence of burnout among human service workers. The OLBI has been developed to overcome some of the psychometric and conceptual limitations of the Maslach Burnout Inventory, the gold standard of burnout measures. There is a lack of data on the structural validity of the Mini Oldenburg Burnout Inventory and the Oldenburg Burnout Inventory in Hungary. Purpose – To assess the structural validity of the Hungarian versions of the Oldenburg Burnout Inventory and the Mini-Oldenburg Burnout Inventory. Methods – We enrolled 564 participants (196 healthcare workers, 104 nurses and 264 clinicians) in three cross-sectional surveys. In our analysis we assessed the construct validity of the instruments using confirmatory factor analysis and internal consistency using coefficient Cronbach’s α. Results – We confirmed the two-dimensional structure (exhaustion and disengagement) of the Mini-Oldenburg Inventory and a shortened version of the Oldenburg Burnout Inventory Internal consistency coefficient confirmed the reliability of the instruments. The burnout appeared more than a 50 percent of the participants in every subsample. The prevalence of exhaustion was above 54.5% in each of the subsamples and the proportion of disengaged clinicians was particularly high (92%). Conclusions – Our findings provide support for the construct validity and reliability of the Hungarian versions of the Mini-Oldenburg Burnout Inventory and a shortened version of the Oldenburg Burnout Inventory in the assessment of burnout among clinicians and nurses in Hungary.]

Clinical Neuroscience

[Neurological aspects of the COVID-19 pandemic caused by the SARS-CoV-2 coronavirus]


[By the spring of 2020 the COVID-19 outbreak caused by the new SARS-CoV-2 coronavirus has become a pandemic, requiring fast and efficient reaction from societies and health care systems all over the world. Fever, coughing and dyspnea are considered the major signs of COVID-19. In addition to the involvement of the respiratory system, the infection may result in other symptoms and signs as well. Based on reports to date, neurological signs or symptoms appear in 30-50% of hospitalized COVID-19 patients, with higher incidence in those with more severe disease. Classical acute neurological syndromes have also been reported to associate with COVID-19. A drop in the volume of services for other acute diseases has been described in countries with healthcare systems focusing on COVID-19. During the COVID-19 epidemic it is also important to provide appropriate continuous care for those with chronic neurological disorders. It will be the task of the future to estimate the collateral damage caused by the COVID-19 epidemic on the outcome of other neurological disorders, and to screen for the possible late neurological complications of the SARS-CoV-2 coronavirus infection.]

Clinical Neuroscience

[Disease burden of Duchenne muscular dystrophy patients and their caregivers]


[Background and purpose - Data on the disease burden of Duchenne Muscular Dystrophy are scarce in Hungary. The aim of this study was to assess patients’ and their caregivers’ health related quality of life and healthcare utilisations. Methods - A cross sectional survey was performed as part of the European BURQOL-RD project. The EQ-5D-5L and Barthel Index questionnaires were applied, health care utilisations and patients’ informal carers were surveyed. Results - One symptomatic female carer, 50 children (boys 94%) and six adult patients (five males) participated in the study, the latter two subgroups were included in the analysis. The average age was 9.7 (SD=4.6) and 24.3 (SD=9.8) years, respectively. Median age at time of diagnosis was three years. The average EQ-5D score among children and adults was 0.198 (SD=0.417) and 0.244 (SD=0.322), respectively, the Barthel Index was 57.6 (SD=29.9) and 53.0 (SD=36.5). Score of satisfaction with healthcare (10-point Likert-scale) was mean 5.3 (SD=2.1) and 5.3 (SD=2.9). 15 children were hospitalised in the past 12 months for mean 12.9 (SD=24.5) days. Two patients received help from professional carer. 25 children (mean age 11.1, SD=4.4 years) were helped/supervisied by principal informal carer (parent) for mean 90.1 (SD=44.4) hours/week and further family members helped in 21 cases. Correlation between EQ-5D and Barthel Index was strong and significant (0.731; p<0.01) as well as with informal care time (-0.770; p<0.01), but correlation with satisfaction with health care was not significant (EQ-5D: 0.241; Barthel Index: 0.219; informal care: -0.142). Conclusion - Duchenne muscular dystrophy leads to a significant deterioration in the quality of life of patients. Parents play outstanding role in the care of affected children. This study is the first in the Central and Eastern European region that provides quality of life data in this rare disease for further health economic studies.]