Lege Artis Medicinae

[Traditional healers in the ancient Egypt]

GYŐRY Hedvig

JANUARY 20, 2001

Lege Artis Medicinae - 2001;11(01)

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Lege Artis Medicinae

[Hip joint involvement in rheumatoid arthritis: pathological features and orthopaedic treatment]

LAKATOS Tamás, KORÁNYI Ágnes, GUNTHER Tibor, RÁCZ Dénes, UDVARHELYI Iván

[The authors review the orthopaedic surgical treatment possibilities of the hip joint affected by rheumatoid arthritis. In the first part, they draw the attention to the characteristic features of the disease. They describe a possible pathological interpretation of rheumatoid arthritis and emphasize the specific features of the rheumatoid hip joint. Different surgical interventions and treatment possibilities are analyzed. Because of the multiple joint involvement in these patients, the possibility of sequential operations has to be considered. The importance of close cooperation between rheumatologists and orthopaedic surgeons is emphasized. According to the authors, one of the most effective long term treatment possibility of the rheumatoid hip is the total hip arthroplasty.]

Lege Artis Medicinae

[Poet and hedonist - Franz Schubert]

MALINA János

Lege Artis Medicinae

[Salicylates and aspirin]

BÁLINT Péter, WALTER F. Kean, BÁLINT Géza, SZEBENYI Béla, KEMENDY Gábor, WATSON Buchanan

Lege Artis Medicinae

[Abstracts of Hungarian authors’ articles published abroad]

Lege Artis Medicinae

[Handling of complaints of patients rights Mediation procedure in health care]

HEUER Orsolya

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[Computer tomography based planning by personal computer in surgery of forefoot]

HUSZANYIK István, HEGEDŰS Franciska, RÓDE László

[BACKGROUND - In contradiction to traditional osteographic registrations CT pictures give the possibility of precise and size proportional measurements. Three-dimensional reconstructions can help in imaging of stereoscopic structures, however later reediting is not possible. Authors elaborated a CT based system for planning surgical interventions with personal computer. MATERIALS AND METHODS - The new method is described using a forefoot surgery model. The measurements were based on three subcapital osteotomy of 1st metatarsus. The length of 1st metatarsus, the 1st-2nd metatarsus index, the 1st-2nd intermetatarsal angle, and dorsoplantar movement of 1st-2nd metatarsal head were determined. RESULTS - The postoperative result of correction and pathologic bone movement can also precisely determined by this method. CONCLUSION - This method seems to be practical for elaboration of other new operating techniques, predicting and verifying their results before clinical use.]

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[THE ROLE OF REGISTRY ANALYSIS IN THE FORMING OF THERAPEUTIC GUIDELINES IN RENAL TRANSPLANTATION]

PERNER Ferenc, HERCZEG Balázs, SZENOHRADSZKY Pál, ASZTALOS László, KALMÁR-NAGY Károly, JÁRAY Jenő

[The authors assess the two main outcomes of the immunosuppressive therapy after renal transplantation: graft and patient survival. According to their view, evidence from randomised clinical trials results can be well complemented by the several unique transplant registries and outcome research based upon these databases. The comparison of evidence from these two sources addresses the question of achievable outcome under ideal (controlled) versus real life conditions. Based on a systematic review of the relevant clinical trials and registries it can be stated, that in the case of some immunosuppressants (mycophenolate mofetil vs azathioprine, microemulsified cyclosporin vs cyclosporin and tacrolimus vs cyclosporin) the improvement in the intermediate outcome can lead to improved graft and patient survival, while in the case of other drugs no significant difference in hard endpoints were detected (tacrolimus vs microemulsified cyclosporin). Evidence on graft and patient survival differences could not be derived from traditional randomised clinical trials, only from transplant registries. For the sake of improved evidence based therapeutic guidelines in renal transplantation, authors call for further development of the Hungarian transplant registry.]

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[The role of metformin in the glucose-lowering therapy of patients with type 2 diabetes]

JERMENDY György

[Metformin is the oral antidiabetic drug of choice for patients with type 2 diabetes. Its effect is predominantly based on the reduction of insulin resistance by inhibiting hepatic glucose production. Metformin can be used as an initial oral antidiabetic drug at the start of, or in case of the failure of lifestyle modifications. Metformin is also used in dual or triple oral antidiabetic combinations, however, its use should not be suspended even if initiation of insulin therapy is indicated in patients with type 2 diabetes. Metformin does not increase bodyweight and the risk of hypoglycaemia, and recent data suggest that it decreases the risk of tumour development. Today, an extended- release (XR) formulation is also available besides the traditional one, which not only simplifies the treatment, but might also reduce the incidence of gastrointestinal adverse effects.]

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[TREATMENT APPROACHES OF CHRONIC HEPATITIS B IN HUNGARY]

TORNAI István, NEMESÁNSZKY Elemér

[Today, there are less patients with active chronic hepatitis B requiring treatment than patients with chronic hepatitis C. However, the course and outcome of chronic hepatitis B is usually more severe, therefore, the disease has not lost importance. The most dangerous risks are the development of liver cirrhosis and hepatocellular carcinoma. The disease may present in various forms. Symptom-free carriers only need follow-up and hepatologic care. In the active stages with elevated liver enzymes and high level of viral nucleic acid (either HBeAg negative or positive), however, antiviral treatment is strongly indicated. There are two main forms of treatment. Alfa-interferon-based therapy, which is applied for a defined period of time, has a direct antiviral and immunomodulatory effect, but has several adverse effects. Long-term nucleoside analogue treatment represent the other treatment modality. These drugs are administered orally, have minimal side effects, but after some time resistant mutants may develop. Traditional interferon has recently been replaced by pegylated interferon alfa-2a with much better pharmacokinetic properties. Lamivudine has been in use for the longest time of the nucleoside analogues. Its efficacy is high, but after 3 to 4 years of treatment, resistant mutants appear in about 70% of cases. Of the most recent compounds, adefovir dipivoxil has recently become available in Hungary; it is primarily recommended in cases with lamivudine resistant mutants. There are promising new drugs in the stages of clinical trial; of these, entecavir has already been approved in the United States.]

Journal of Nursing Theory and Practice

[The simulator-based education methodology]

CSÓKA Mária, VINGENDER István

[The advantage of the simulator-based education is that while students could previously only practice the procedures for certain tests and treatments using demonstration equipment, with the simulator they can now also monitor the effects of the treatments. The objectives of the simulation-based course were determined based on the premise that practicing a healthcare profession does not usually require students to say or write down what they know, but to be capable to use their skills in the course of treating patients, in various situations, for the resolution of a diversity of tasks and problems. In the simulation exercises they fi nd themselves in situations where, through simulations of physiological and chronic conditions they have an opportunity to observe the normal and pathological functioning of the human body, to be a part of the whole treatment process, and to develop their professional skills through constant interaction. The authors give a brief overview of the opportunities for application of clinical simulations in an educational setting, and also describe how they incorporated the practice-room programs based on the patient simulator into the syllabi of the various departments, and how the traditional teachercentred imparting of knowledge can be replaced by problem-based learning in an open, multimedia study environment. They systemise their learning and teaching methods, and use specifi c examples to demonstrate which target skills can be achieved with problem-oriented teaching methods.]