Lege Artis Medicinae

[The Social Security Health Insurance Fund's Mental Hygiene Board of Trustees]

MAY 26, 1993

Lege Artis Medicinae - 1993;3(05)

[The Board of Trustees of the Social Insurance Health Insurance Fund for Mental Hygiene invites applications for the implementation of mental health promotion and mental hygiene programmes from the fund allocated by Parliament from the 1993 social insurance budget, pursuant to Act LXXXIV of 1992. ]

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Lege Artis Medicinae

[The prerequisite of T cell recognition: antigen processing and presentation]

RAJNAVÖLGYI Éva

[Multiple regulatory mechnanisms are activated wit hin the immune system to maintain the homeostasis of the organism. A key element of these processes is the specific recognition of antigens mediated by T and B lymphocytes. This is the basis of clonal selection and antigen specific activation of the immune system (LAM 1991. 1(18):1308–1314.) which results in the most efficient elimination of the antigen. T cells play a predominant role in the discrimination of self and non-self structures. Antigen specific activation of T cells results in the expression of cell surface molecules and in the production of different lymphokines of high biological activity, which define the possibilities for cell to cell interactions and influence the function of different cell types affecting the outcome of the immune response. The appropriate activity of functionally distinct T cells enables the most efficient mobilization of effector mechanisms leading to the elimination of the antigen without destroying self components. In order to exert their regulatory and effector functions they require a well regulated collaboration with antigen presenting cells. This review summarizes our present knowledge on the intracellular degradation and transportation pathways occuring on in antigen presenting cells determining the antigen specific functions of T cells. It is well established that these events influence the efficacy or protection against pathogens and have a basic influence on the normal or pathological outcome of autoimmunity.]

Lege Artis Medicinae

[Thoughts on radical hysterectomy]

BŐSZE Péter

[Radical hysterectomy and pelvic lymphade nectomy have been used for the treatment of carcinoma of the uterine cervix in most Western countries for decades. These surgical procedures, however, have rarely been advocated in Hungary. Advantages and disadvantages of radical hysterectomy with pelvic and paraaortic lymph node dissection are discussed. Emphasis is placed on patient selection. It is the author's view that radical surgery does have a place in the management of cervical cancer. The patient should be informed about the possible treatment modalities available such as radical surgery, radical radiation therapy or a combination of surgery and irradiation, and she should be involved in the decision making process. Radical hysterectomy with pelvic lympha denectomy is a major operation with potentially significant intraoperative and postoperative complications. A dequate surgical skill and sufficient experience are required and this procedure should be regularly practiced. For these reasons, it is probably best performed in cancer centres.]

Lege Artis Medicinae

[The role of computed tomography in tumor staging of bronchogenic carcinoma]

HEILER Zoltán, PÁLFFY Gyula, KOSTIC Szilárd, MONOSTORI Zsuzsanna, REPA Imre

[Operability of lung cancer is based on the size and local extension of the tumor as well as the presence of lymph node and distant metastases. Agreement and disagreement between CT and surgical tumor staging was investigated for 197 cancer patients after surgery. Sensitivity and specificity of CT prediction ranged 57–93% and 71–100% ac cording to tumor stadium. CT diagnosis has been relatively unreliable in describing tumor propagation along the pulmonary veins (less frequently arteries) towards the atrium and in recognizing a discrete tumor invasion of the mediastinum. Local thickening of the parietal pericardium, and small pericardial effusion have been considered as indirect signs of pericardial tumor infiltration. MR examination have been found to be a supplemental technique for assessing tumor spread to the great vessels of the mediastinum. The authors believe on the results that new techniques, such as MR angiography and indirect CT signs will help in making a more accurate preoperative diagnosis of lung cancer.]

Lege Artis Medicinae

[Report on gastroenterological endoscopic activity in Hungary in 1992]

NAGY György, JUHÁSZ László

[At the request and on behalf of the Endoscopic Section of the Hungarian Gastroenterological Society, we have compiled the main data of the Hungarian endoscopic activity in 1992. We received responses to our questionnaire from 117 endoscopic laboratories and one private endoscopic practice. The responses received were summarised in a table.]

Lege Artis Medicinae

[Heparin-Aspirin Reperfusion Trial]

MATOS Lajos

[Treatment efficacy was first assessed 7-24 hours after the start of rt-PA infusion: at this time, the coronary artery leading to the infarct was patency in 82% of patients also receiving heparin therapy, compared to 52% of patients receiving aspirin supplementation (p<0.0001). Vessels that were patency-free at the first test remained open in 80% of those also treated with heparin after one week, the same was 95% in those treated with aspirin (non-significant). Bleeding was observed in 18 patients in the heparin group and 15 in the aspirin group. Ischaemic events were observed in eight cases in the former group and in two cases in the latter group - these were not statistically significantly different. The mortality rate was 1.9% in the heparin group and 4.0% in the aspirin group. ]

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KAPÓCS Gábor

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

VASTAGH Ildikó, SZŐCS Ildikó, OBERFRANK Ferenc, AJTAY András, BERECZKI Dániel

[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. ]

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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

[Vaccines against COVID-19 pandemic]

FALUS András, SZEKANECZ Zoltán

[The rapidly spreading SARS-CoV2 respiratory virus has evoked an epidemic with serious aftermath around the world. In addition to the health effects, the global economic damage is actually unpredictable. At the same time, the pandemic has launched a series of unprecedented collaborative scientific research, including the development of vaccines. This study summarizes up-to-date information on vaccines, immune memory, and some emerging clinical effects.]

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.]