Lege Artis Medicinae

[The chronicle of haemophilia]

ISTVÁN Lajos

JULY 31, 1991

Lege Artis Medicinae - 1991;1(13)

[There are numerous cultural, historical and medical records of haemophilia, which date back to the 2nd century BC. These provide an opportunity to study the nature, symptoms and heredity of the disease retrospectively. ]

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[Diagnosis and treatment of neck pain II. Treatment]

BÁLINT Géza, SZEBENYI Béla, BÁLINT Péter

[The treatment of neck pain – such as the diagnostic procedure – requires the collaboration of the general practicioner and rheumatologic, neurologic; traumatologic and orthopedic experts. This part of the article interpretes methods and possibilities which can be made or prescribed by all the collegues for such patients. In case of acute neck pain bedrest, fixing instruments, peros medicamentation, local injections and physiotherapy are recommended. Patients suffering from chronic neck pain should be treated with active gymnastics, physiotherapic and relaxation methods rather than with oral therapy to avoid medical polypragmasy. Psychic running of these patients are emphasised. The authors conclude that general practicioners should play greater role in the treatment of neck pain, such as of arthrosis or backache.]

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[Congenital haemorrhagic diathesis in childhood- an update]

ZIMONYI Ilona, MAROSI Anikó, JÁNKY Ilona

[Following 164 haemophilic children in the Heim Pál Children's Hospital the authors call attention to the increased responsibility of paediatricians in diagnosis and long term care. They highlight haemarthroses leading to disableness, dental care, and the hazards of the treatment, such as changes in the immunstatus, transfer of infections, and the appearence of inhibitors. Hepatitis B profilaxis, introduced last year is mentioned as a favorable result. They call attention to the bad school results of the patients with average intelligence, the difficulties in the choice of profession and adaptation. They emphasize that the solution of the problems is an averall social duty. Finally, problems to be solved in the near future are listed. ]

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[The clinical pathology of prostatic carcinoma]

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[On the basis of the actual state of art, the main tasks of clinical pathologists in the diagnostics of prostatic carcinoma may be summarized as follows: Recognition and differential diagnosis of prostatic adenocarcinoma. Estimation of tumour prognosis by means of a reliable histological grading system and establishing the pathological stage. Checking the efficacy of (hormonal) treatment relying upon histological features. An increasing effort to a better understanding and diagnosis of premalignant changes (dysplasia, prostatic intraepithelial neoplasia). In favour of individual characterization of a tumour, one should utilize the attainable modern investigative methods.]

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[The role of the estracyt therapy in the treatment of prostatic cancer]

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[The authors – after summarizing the literature data – report the experiences of 57 prostatic cancer patients treated with Estracyt. The therapy was introduced as a primary one in 22 cases, and as a secondary treatment in 35 ones. It was administered mostly in T3-4 stadium cases with proved metastases. There was a complete regression in 8, partial regression in 15, while temporary regression in 14 cases (totally 64,9%). It is suggested, that the product can be used ensuring regression by the development of hormone resistance, by anaplastic tumors, and at the evolving of the recidiva following surgery or irradiation. A complete regression can be reached relatively rarely in advanced tumors. It can be used in either primary or secondary therapy. ]

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[Diagnosis and therapy of prostate cancer]

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[A short chronicle of three decades ]

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[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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[Haemophilia is the most well-known inherited bleeding disorder, which has an X-linked inheritance and affects men. Its severity is classified on the basis of the amount of circulating functional clotting factors: patients with values < 1% have severe disease, those with values of 1-5% have moderate disease, and those with values >5% are classified as having mild disease. Severe haemophilia is characterised by frequent, spontaneous bleeding episodes, whereas in those with moderate or mild haemophilia, bleeding is only caused by trauma or surgery. Although bleeding can occur almost anywhere, the most common clinical manifestation is haemarthrosis. Haemophilic arthrpathy that develops as a result of repeated episodes of joint haemorrhage is the most important factor of morbidity in those with haemophilia. Intravenous replacement of the missing clotting factor is used to treat and prevent bleeding episodes. Controlled therapy at home that provides immediate replacement is the optimal early approach. Prophylaxis includes administration of clotting factors at regular intervals to prevent bleeding, which must be the main goal of management until a cure becomes available. The development of inhibitors during treatment is the most significant complication of factor replacement, and management of bleeding in patients with such inhibitors is difficult.]

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[The authors present a case of herniated diso operation in a haemophilic A patient whose bleeding disorder had not been diagnosed earlier. They draw attention to the importance of inquiring about haemophilia in the case of surgery and the laboratory screening tests. Special aspects of preoperative examinations, the operation and follow-up treatment are described.]