Lege Artis Medicinae

[The issue of dental care reform]

KINCSES Gyula

NOVEMBER 30, 1993

Lege Artis Medicinae - 1993;3(11)

[After repeated consultations and amendments, the reform of dental care cannot be delayed any longer. A decision on a concrete target model must be taken soon to ensure that the reform can be implemented next year, and concrete, detailed professional work and data collection must begin to ensure feasibility in 1994. ]

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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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[LAM 30: 1990–2020. Facing the mirror: Three decades of LAM, the Hungarian medicine and health care system]

KAPÓCS Gábor

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.

Clinical Neuroscience

[What happens to vertiginous population after emission from the Emergency Department?]

MAIHOUB Stefani, MOLNÁR András, CSIKÓS András, KANIZSAI Péter, TAMÁS László, SZIRMAI Ágnes

[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.]

Lege Artis Medicinae

[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.]

Lege Artis Medicinae

[Diagnosis and treatment of microvascular coronary heart disease. Specialities of conditions in Hungary]

SZAUDER Ipoly

[Invasive investigations show that in two-thirds of patients the myocardial ischaemia persists without obstructive coronary disease and any other heart conditions (INOCA). The underlying cause may be microvascular dysfunction (CMD) with consecutive microvascular coronary disease (MVD) and microvascular or epicardial vasospastic angina (MVA). The modern practice of clinical cardiology while using the developed non-invasive cardiac imaging permits exact measuring of the coronary flow with its characteristic indices. All of these improve the diagnosing of CMD-induced myocardial ischemia and provide opportunity to determine primary MVD cases. Since the recognition and treatment of MVD is significantly underrep­resented in the Hungarian medical care, the primary stable microvascular angina (MVA) is described in detail below with its modern invasive and non-invasive differential diagnosis and treatment, concerning especially its frequency provoked by high blood pressure and female coronary heart diseases. There are highlighted all recommended diagnostic procedures available under domestic conditions.]