Lege Artis Medicinae

[Who is in favour?]

LÁSZLÓ András

NOVEMBER 30, 1992

Lege Artis Medicinae - 1992;2(11)

[It turns out that the concept of a state guarantee is a confusing, almost elusive one. The Constitution, and subsequently the 1991 Parliamentary Resolution on social security and health care, define social security as a social benefit system "guaranteed by the state", but do not say what the state guarantees. The government, and subsequently the 1992 Social Security Budget Act of 1991, interpreted it as guaranteeing the benefits themselves, i.e. the payment of pensions and health services with vaguely defined limits. ]

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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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[Epilepsy in coronavirus pandemic]

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[We aim to review the impact of COVID-19 pandemic on epilepsy and epilepsy-care. While the virus has no specific link with epilepsy, it may affect the nervous system both directly and indirectly, leading to seizures in several ways. The hyper-coagulable state occurring with the infection may cause strokes leading to seizures. The infection may first manifest in the form of disturbances of consciousness and behaviour, seizures, and even status epilepticus. The interactions of antiviral/antiepileptic drugs need to be taken into account during treatment. The hypercoagulable state induced by COVID-2 infection may cause stroke, which leads to seizures. The infection can occur also as an impaired consciousness of non-epileptic origin. Interactions of antiviral/antiepileptic drugs have also to be taken into account. The pandemic itself as well as quarantines and social distancing may cause anxiety and insomnia, challenge continuous antiepileptic supply; each one carrying the risk of seizing. Young epilepsy patients with learning disabilities and mental health issues are most vulnerable, justifying their hyper-protection. The danger of infection has highlighted the role of telemedicine. Internet-based video communication may ensure full care for chro­nic patients. Those methods favour bes­­ted patients with higher education. Epilepsy does not increase directly the risk of infection, but its comorbidities may worsen the course of the disease. Brain lesions and hypoxia, stress, insomnia and fever joining the infection increase seizure susceptibility. Because the danger of infection ma­de telemedicine an essential tool of pa­tient care, education and better computer supply for those in need is crucial. ]

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[In mostly the second part of the last decade lots of epidemiological study have been released about the progression of the chronic kidney disease (CKD) and theirs connection with the risk of death. The fact that lots of nephrologist from all over the world (from Canada to New-Zealand) are pretty much interested in this topic is absolutely proved by national (REIN Study – French Registry) and international (KDIGO Controversies Conference, DOPPS 1-5, or the European AROII Study) researchers with these epidemiological questions in their focus. The risk estimation facts that are able to show the life expectancy of patients with CKD 3-5 (expected time to dialysis or mortality risk before renal replacement therapy – RRT) and the early or hopefully longer survival odds of the dialyzed ones could be very useful not only for the medical stuff but also for the patients. In case of the predialyzed patients the focus has to be on the Bansal score and also on the Kidney Failure Risk Equation (KFRE) scores (with 4 and 8 variable); on the other hand in dialyzed patients the REIN score that prognose a short-term survival and the Cohen model (both are easy calculated with webcalculators) are in the highlight of importance. There is not a big difference (2- 7%) in validated researches between the prognosed and the real survival dates. Despite of this prediction has to always be evaluated individually in favour of the best decision we can make for the patients and in order to choose the right treatment: conservative therapy, dialysis or transplantation.]

Clinical Neuroscience

[The concept of epileptic networks. Part 2.]

HALÁSZ Péter

[In this paper we investigate evidences supporting the network concept of epilepsies from different approaches. Firstly the functions of cortical networks in which most of the epileptic networks are embedded, are treated. Then the tentative characteristics of an epileptic network are enumerated and the conversion mechanisms from physiological to epileptic networks are analyzed. Later the role of neuronal oscillations in epileptic networks and aspects of epilepsies provoked by sensory and cognitive tasks is studied. Lastly new fMRI data in mapping BOLD networks underlying spike and seizure discharges are used as arguments in favour of the epileptic network hypothesis. In a second part the well-known epilepsies related, or probably related to physiological networks are shown. Finally consequences of the network approach for creating a new unified epilepsy classification are discussed.]

Clinical Neuroscience

[The concept of epileptic networks. Part 1.]

HALÁSZ Péter

[In this paper we investigate evidences supporting the network concept of epilepsies from different approaches. Firstly the functions of cortical networks in which most of the epileptic networks are embedded, are treated. Then the tentative characteristics of an epileptic network are enumerated and the conversion mechanisms from physiological to epileptic networks are analyzed. Later the role of neuronal oscillations in epileptic networks and aspects of epilepsies provoked by sensory and cognitive tasks is studied. Lastly new fMRI data in mapping BOLD networks underlying spike and seizure discharges are used as arguments in favour of the epileptic network hypothesis. In a second part the well-known epilepsies related, or probably related to physiological networks are shown. Finally consequences of the network approach for creating a new unified epilepsy classification are discussed.]

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