Search results

Lege Artis Medicinae

SEPTEMBER 20, 2018

[Medical aid in dying or physician assisted suicide]


[The paper reflects upon the process in which physician assisted suicide, as it is traditionally called, is being reinterpreted. First, changes in word usage shall be demonstrated by examples taken form the relevant US laws and statements of prestigious US organisations. Then the interpretive possibilities of suicide, as it is traditionally called, and their consequencies are discussed. In this context the present state of art of the Hungarian criminal law is briefly presented. Finally some remarks on the normative element of the practice are made. ]

Lege Artis Medicinae

JUNE 20, 2018

[The “room” for death in the family - dying as a role]


[The Hungarian literature has quite ignored so far Noyes & Clancy’s Role Theory approach of dying. I present the outline and a critique of this conception, then lay the foundations of a reformed concept of the dying role. For the optimal and desired dying role is not one of peripherising and objectifying, rather one of placing the dying in the centre of the system of relations and roles radically restructuring under the influence of such role. The personality of the dying remains a true value in this central position. The reintegration of the dying can begin parallel to her disintegration by the progressive loss of her normal social roles (‘the loneliness of the dying’). Death can thus transform into a social phenomenon. I illustrate the argumentation on the central dying role with a case study using the method of a heterophenomenological, second-person character. By promoting the central and autonomous dying role, i.e. by the development of the necessary social role competences, or at least by publicising the thanatological knowledge, death can turn from an avoided, socially disintegrative taboo into a phenomenon that can strengthen the community even after the dying departed.]

Lege Artis Medicinae

SEPTEMBER 20, 2017

[United Nations program to reduce premature cardiovascular mortality by 2025 and the estimation of the success of the program]


[Worldwide surveys show that cardiovascular (CV) mortality is the decisive element of total mortality. Between 1990 and 2013, the absolute number of CV deaths increased by 40.8%. Within this, ischemic heart disease (IHD) and stroke, such as the two main elements of mortality, have also increased to such an extent. Compared to the increase in absolute deaths, the age-standardized mortality rate per 100,000 population declined by 21.9%. The cause of the paradox is the development of therapy and the increase in the average age of the population. What is decisive for the lost life years (YLL) in CV cause of deaths IHD is moved from 4th to 1st place, stroke from 5th to third. This change is typical in the most regions of the world, including Central Europe and, above all, Hungary. The following factors contribute to increasing IHD and stroke mortality: smoking, hypertension, obesity, physical inactivity, diabetes. In 2011, the United Nations Conference on Communicable Diseases a uniform resolution was made, that it is a key objective for all nations to reduce their premature mortality by 25% in 2025. The CV diseases have been highlighted in a separate program and their name was “Heart of 25 by 25”. The main objective is to reduce the of premature CV mortality (probability of dying between 30 and 70 years). The target consists of main points: 30% reduction in smoking, 25% reduction in the prevalence of high blood pressure, halt the rise in obesity and diabetes type 2. Worldwide estimations were made on what would be expected in 2025 when the program was successful or unsuccessful. If the current trend remains then 30% in women and 34% in men would increase premature mortality. If all factors are influenced, then the increase will be only 1% for women and a reduction by 6% for men for developed countries, a reduction in both sexes would exceed 20%.]

Hypertension and nephrology

MAY 20, 2017

[Isolated systolic hypertension in children and young adults I.]


[Prevalence of the isolated increase in systolic blood pressure ≥140 mmHg with normal or low diastolic blood pressure ≤80 mmHg, is defined as isolated systolic hypertension. Its prevalence increases with age up to >90% in patients aged >90 years. Isolated systolic hypertension is also found in the young and the clinical significance of it is still debated. For the therapy, those drugs should be used which have a license for use in children: angiotensin converting enzyme inhibitors, angiotensin AT-1 receptor antagonists, calcium channel blockers beta-blockers and diuretics and their combinations. The young adults with isolated systolic hypertension had a much higher risk of dying from coronary heart disease or cardiovascular disease, then the normotensive individuals, and should be treated to normalise their blood pressure. In the elderly and very elderly (>80 yrs), a wealth of data from large clinical trials are available, showing the necessity of treatment mostly with drug combinations - fix-combinations are preferred for increasing the adherence / persistence to therapy. Using diuretics, ACE-inhibitors / ARBs with calcium antagonists, and when needed diuretics and beta-blockers are suggested by recent European guidelines. The target is <140 mmHg, but in octogenarians <150 mmHg. Some studies are pressing for even lower SBP (to around 120 mm Hg), but it seems to be wise to balance advantages / disadvantages, so the optimal SBP may be around 130 mmHg.]

Lege Artis Medicinae

JUNE 20, 2016

[Music therapy in hospice care]


[The study gives a short review of some music therapy methods can be applied on the field of hospice care. Its aim is drawing the attention to the topic and enhancement of the method in the hospice movement in Hungary. The results of research works support the idea of applying both active and receptive music therapy for ensuring advantageous results in high quality care provided for dying patients. Properly chosen musical interventions applied by qualified music therapists within a therapeutic relationship are able to improve amongst others the quality of life of dying people by ensuring their inner peace, reducing the feeling of pain and anxiety and supporting their psychical-spiritual development. Besides the dying patients, hospice workers and the relatives of the patients can also experience the benefits of music therapy. ]

Lege Artis Medicinae

APRIL 20, 2016

[What does the „whole”-ness of patients with diabetes mellitus mean?]


[Diabetes mellitus is a chronic, progressive disease, characterized by elevated levels of blood glucose, can lead to many complications and can increase the overall risk of early disability and dying prematurely. The newest guidelines on management of patients with diabetes mellitus give a full description of diagnostic criteria, prevention, lifestyle and pharmacological treatment, complications, age-related characteristics. However, in everyday care of patients with diabetes mellitus little attention is paid to severity of anatomical and functional impairment related to disease, how and in what extent those limit everyday activities, restricts filling the social role, the importance of interrelationship of a human being and environment, to personal factors. The aims of this publication is: to present how diabetes mellitus influences the entirety, the “whole”-ness of a human; to show tools of objective estimation of impairments and changes of functionality; to call attention to importance of development of residual abilities, of shaping supportive environment, of assessment of needs, of positive influences of personal characteristics; to demonstrate how all these measures improve quality of life and compliance of patient with diabetes mellitus. The holistic approach of “human’s whole-ness” can contribute to success of preventive, curative and rehabilitative measures in patients with diabetes mellitus.]

Clinical Neuroscience

DECEMBER 20, 2003

[Thallium poisoning induced polyneuropathy - clinical and electrophysiological data]


[Introduction - The aim of the study was the electrophysiological investigation of thallium induced polyneuropathy. Beyond the rarity of the illness, the motivation of this work was the possibility of following up the pattern of neuronal damage. Thallium is one of the most toxic heavy metal and its wide use increases the chance of chronic or accidental acute poisoning. The entero-hepatic circulation makes the accumulation of this toxic agent in tissues possible, mostly in neurons, in the epithelial cells of the digestive tract, in the germinative cells of the skin and testicles. In addition to alopecia and digestive complaints, the clinical picture of thallium poisoning is dominated by neurological signs. Severe axonal polyneuropathy develops in almost all cases, with further damage to the retina and impairment of cognitive functions being not unusual. The diagnosis is confirmed by finding high levels of thallium in body fluids, especially in saliva and urine. Case report - Electrophysiological examination of our accidentally poisoned patient revealed severe, sensory-motor, predominant motor axonal polyneuropathy and pointed out some aspects of the pattern of neurotoxic process: the initially distal lesion, the dying-back course and the capacity for regeneration. Conclusion - Because thallium has the same molecular targets as potassium ion thus impairing the energetical supply of the nerve cell, the most effective treatment is carefully loading with potassium. If recognized and treated early, thallium poisoning has a favourable prognosis.]

Lege Artis Medicinae

JUNE 20, 2003

[End-of-life care]


[Recently, physicians and medical literature are more concerned about end-of-life care. A review is given of studies dealing with the rights of the dying patient, with advance directives and with possible treatments in the last days of life. A survey was done in author's department on medical therapy of the terminal period of 103 inpatients, died between 01. 10. 2001. and 31. 03. 2002. Comparing these data with those of American, Finnish etc. authors, the treatments seem to be more generous - probably because in Hungary it is not (yet?) usual to ”declare” endof- life care and to withdraw active therapy. However, indication of antibiotics seems to be more clinical (28.1%, vs. 42%-88% given by similar foreign data). Antibiotics are not palliative means, however, they may be administered in the last days, if the patient is suffering from a terminal infection. Indications and choice of antibiotics are suggested in these cases; medical and ethical problems discussed. Physicians can relieve the physical and mental distressing symptoms of the dying patient and ensure human dignity and peace of the last days.]