Lege Artis Medicinae

[Voluntary organisations in the health sector, American experience]

VERESS Katalin1

NOVEMBER 30, 1992

Lege Artis Medicinae - 1992;2(11)

[The international organisation "Universities for Democracy" was founded in Budapest in November 1990. The aim of the cooperation between the American and Central and Eastern European universities participating in it is to increase the role of universities (higher education institutions) in the democratic changes in Central and Eastern Europe, in the creation of institutions of democracy, in the development of the economy, and in the promotion of intellectual and cultural exchange between these two regions of the world.]

AFFILIATIONS

  1. SOTE Közegészségtani és Járványtani Intézet

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[The beta-adrenoceptor blocking drugs]

KÉKES Ede

[The beta-blockers have been primary in cardiovascular pharmacology since the 1960's. Clinical experiences in the last 25 years have confirmed that the beta-adrenergic blockade is essential in treating the different forms of angina pectoris. Hypertension, hypertrophic cardiomyopathy, and all situations including acute myocardial infarction and some rhythm disturbances qualified by sympathetic overdrive. The beta-blockers have been shown in large scale clinical trials to reduce the cardio vascular morbidity and mortality associated with hypertension and post-infarction period. The possibility of using them as a combined therapy with a great number of other drugs without any difficulties, is very important. Toxicity is rare with beta-blockers and the side effect profile is generally good. There fore, there is no question that the risk/benefit ratio is weighted toward the benefit. Nevertheless there are some problems such as hemodynamic profile, and effects on lipid metabolism, etc. Research has advanced from the first generation to the third generation with direct or indirect effects on the vascular bed, producing strong vasodilation. Because of the above mentioned facts, it is essential to know correctly the pharmacological effects and precise pharmacokinetics, of the beta-blockers.]

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[Calcitonin-secreting ovarian strumal carcinoid]

ÉSIK Olga, NÉMETH György, SZEPESHÁZI Károly

[On the basis of a case report, the clinical picture, pathologic characteristics and possible histogenesis of ovarian strumal carcinoid are discussed. A 3 mm strumal carcinoid, i.e. thyroid tissue intimately mixed with a calcitonin-secreting neuroectodermal tumour, was found in a mature ovarian cystic teratoma of a 38 year old woman. Although the thyroid component demonstrated a typical normal light microscopic appearance, no thyroglobulin and thyroxine were found immunohistochemically. Immunoreactive calcitonin was demonstrated within the tumour cells, even in the transitional zone of the biphasic tissue elements. No amyloid was detected. The argentaffin and argyrophilic reactions were negative. The close relationship between functionally imperfect thyroid tissue and a neuroendocrine marker-secreting tumour seems to be concordant with the theory of the existence of a pluripotential stem cell capable of differentiating multidirectionally.]

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[Plasma Exchange]

JÁKÓ János, SCHOPPER János

[As a technique, is one of the indispensable means of supportiv therapy. Possibilities and approaches representing new trends of up to date therapy are offered by its application. Such approaches are, the nonsubstitutive application of IVIG, or exploiting the advantages of the functioning LAK and TIL cells. However, the authors also point out dangers of this technique, therefore plasma exchange should be applied only after thorough consideration. ]

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[A new operative technique in the internal carotid artery surgery]

ENTZ László, MOGÁN István, JÁRÁNYI Zsuzsa, PAPP Sándor, NEMES Atilla

[The primary author spent one year at the Vascular Department of Nurenberg Town Hospital where an opportunity presented it self to get acquainted with a new surgical method. The eversion endarterectomy of the carotid artery has been developed by the Nurenberg team in 1985. Since that time more then 1500 operations of this type was performed. Using the experiences gained in Nurenberg, the author introduced this new method at the Budapest Cardiovascular Surgery Clinic as well, and from January 1, 1991 until June 30, 1992, 213 operations were performed. Concerning short term results the new method is acceptable compared to the traditional methods. Owing to the method being a new one, long term results can only be read about from 2 authors. After a five year postoperative period restenosis of 1,3 percent was found after 212 operations by Kieny and after 105 operations, a 1.9 percent was reported by Kasprzak. These results seem to be encouraging if they are compared to the 10–25% restenosis rate of traditional operations. ]

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[APSAC Intervention Mortality Study]

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[Within 30 days of the infarct, 12.2% of the placebo group and 6.4% of the APSAC group had died. The active agent reduced mortality at 30 days by a mean of 47.5% (21-65%) within a 95% confidence interval. Side effects and adverse effects were rare.]

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[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

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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.

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[Vaccines against COVID-19 pandemic]

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[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.]

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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.]