Lege Artis Medicinae

[We heard it - we'll pass it on]

NAGY András László

NOVEMBER 30, 1993

Lege Artis Medicinae - 1993;3(11)

[A good number of doctors are participating in the growing number of forums, attending doctors' club debates to ask questions of the people in charge, trying to get first-hand information... But it is not without risk if one wishes to broaden one's horizons, to get to know the thoughts of the moment, the questions of one's colleagues, the doubts of one's colleagues that need to be answered. Those who not only wish to use their knowledge and understanding among colleagues, but also wish to solve their existential problems and solve their dilemmas on the basis of the information they have just gained, may be at a loss.]

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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.]

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[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. ]

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[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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[This research focused on the knowledge and attitude toward to electroconvulsive therapy (ECT) in the general population of Hungary. There are only a few studies in the international literature focusing on the public’s attitude towards ECT, and no such study has been published from Hungary. Participants were reached through social media and asked to fill out a semi-structured questionnaire on internet that comprised seventeen questions. Participation in the survey was entirely voluntary and anonymous. Participants of the survey were not working in health care; their answers to the questionnaire were compared to those of health-care workers. The result showed a significant difference between healthcare workers’ and lay people’s knowledge and attitude towards ECT. Two third of lay participants have never heard about ECT. Those familiar with ECT were relatively well-informed about its certain aspects yet rejection of ECT was significantly higher in the group of lay participants than in health-care workers. Lay people’s incomplete knowledge and negative attitude towards ECT was confirmed by this survey. The dissemination of reliable information – which should be the shared responsibility of mental health professionals and the media – would be vitally important to disperse the prejudices and doubts about ECT.]

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[We heard in forums]

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[The 1993 Social Security Budget Act and, as part of it, a series of provisions setting out the way forward for the reform of primary care and initiating the reform of specialised care. However, the government and ministerial decrees implementing the provisions and setting out the technical details are not yet known. Health professionals are still full of uncertainty and doubt. The time has come once again for forums in which the leaders of health policy - the authors of the laws and the drafters of the expected regulations - give presentations explaining and justifying what has already happened and informing about expected developments. At the same time, of course, they "sound out public opinion". The huge interest that greeted the speakers at the first forum of the "season" of the complementary event of the International Medical Technology Exhibition in the Theoretical Block of the SOTE Oradea Square, was not so much a sign of the organisers' success as of the doctors' lack of information, their uncertainty and their hunger for information.]

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[Reflections on the teaching of medicine]

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