[Cardiovascular risk factors in essential hypertension]. / A magasvérnyomás-betegségben elóforduló cardiovascularis rizikófaktorok.

Authors analysed the cardiovascular risk factors, their relationship to each other, the rate of multiple appearance in 1476 patients (774 men, 702 women) with essential hypertension. They produced a special questionnaire and risk factor analysing program for performing static and dynamic investigations on the base of international and domestic experiences. The data of their investigations verified, that the occurrence of obesity is very frequent and is associated with abnormal cholesterol and triglyceride values. The appearance of glucose metabolism disorder was in 44% of patients. The rate of metabolic syndrome can be estimated on 25-30% in the hypertensive population.

[Current status and possibilities of distant education in medicine]. / A távoktatás jelenlegi helyzete és lehetöségei a medicinában. I

Author analyses the concept and methods of distance education. The definition of distance education consist of geographic separation of the learner and the teacher, the high level of educational organisation, the use of modern technology for communication with interactivity. Before the widespread use of electronic communications for teaching and learning, the conventional method for distance education was the books and postal service. Since the mid 1980's the attention shifted to the computer technology and computer networks the internet is radically different with previous electronic media. Pfaffenberger estimated in 1994, that by 1998 about 100 million people would have access to the Internet. The web servers gives a multimedia environment, which potencially can provide a truely integrated teaching and learning system to educators worldwide.

[Captopril in the treatment of heart failure]. / Captopril szívelégtelenségben.

The author takes the characteristic hemodynamic features and neurohumoral factors associated with heart failure as the starting point for the discussion. He specifies fundamentals of the current strategies and goals of the management of heart failure. Treatment with vasodilatator and ACE inhibitors has paved novel way for treatment of heart failure, because it is not only able to alleviate the symptoms, but also to improve hemodynamic parameters and increase survival. Initiation of treatment at early stage (silent ventricular dysfunction) is able to prevent the development of manifest signs of heart failure. Captopril, a classical ACE inhibitor, is suitable for modern treatment of heart failure, as well for prevention of myocardial remodelling following acute myocardial infarction.

Third generation electronic medical record knowledge based perspectives.

There is a need to develop better electronic medical records. One possible solution is to put more and more 'routine' medical knowledge into systems handling medical records. In this paper, we analyze the current state-of-the-art of knowledge-based medical record handling; we mainly consider the work of Rector et al. [1]. We offer a more detailed 'four level' knowledge level model compared to the 'two level' model of Rector. The EMR of the future might be approached with a top-down method, using the above mentioned 'four level' model.

Testing the knowledge of postgraduate trainees in medicine: a multimedia software package.

1. TASK OF THE PROGRAM. The task of the program is to test the knowledge of applicants at the examination for specialists degrees. The applicants must answer a series of multiple choice test questions, 40% of them are connected to a medical diagnostic image of different modalities e.g., x-ray, 2D gray scale ultrasound, CT, MRI, and endoscopy images. The answer may need simple measurements and finding target areas on the image. The program manages to: test 20 applicants simultaneously in a network, handle a database of questions and images, and document and print out exam results. 2. ORGANIZATIONAL ENVIRONMENT OF THE PROGRAM. The program was developed at the Medical Informatics Department of "Haynal Imre" University of Health Sciences, Budapest (MID-HIETE) according to the needs and intentions of the National Board of Medical Postgraduate Training. The program was sponsored by the OMFB/National Committee of Technical Development, a government agency, and by one of the commercial banks. 3. TECHNICAL ENVIRONMENT OF THE PROGRAM. 4. SCIENTIFIC BASIS. The data bank was developed according to a previous study of medical images in clinical practice. The study describes the information content of different medical images and their role in medical practice. The image data bank originates from the developer's own medical image library and from internationally acknowledged medical textbooks (respecting copyright issues). Knowledge base of questions was drawn from basic international textbooks. 5. SUMMARY. Within a period of two years, the MID-HIETE staff succeeded in developing a modular multimedia software package that tests and screens the knowledge of postgraduate trainees. This screening method is offered as an entrance exam for the specialist degree. Currently, this exam is administered as an oral test; the knowledge of the applicants may therefore not be tested thoroughly.

[Antianginal effect of transdermal isosorbide dinitrate (multicenter study)]. / A transdermalis isosorbid-dinitrát antianginás hatásáról (multicentrikus vizsgálat).

Efficacy of transdermal isosorbid-dinitrate spray was investigated in 167 of 254 patients with stable angina pectoris. The transdermal application of isosorbid-dinitrate decreased successfully the number of anginal attacks and the sublingual nitroglycerin or isosorbid-dinitrate consumption. Very few side effects were observed and the patients well-being was good during treatment.

[Dual-chamber rate responsive cardiac pacing]. / Kétürgü, rate responsive pacemaker kezelés.

The authors describe in this report their first experience with the implantation of a rate responsive, dual chamber pacemaker. They emphasize the advantages of this type of pacemakers: the maintenance of AV-synchrony and the rate increase in response to exercise. Meanwhile they call attention on the complexity of the ECG interpretation.

Anti-anginal effect of Tenormin (atenolol).

The anti-anginal effect of Tenormin (atenolol) has been examined besides placebo control by single blind method in 20 patients with ischaemic heart disease, suffering from stable effort angina proved by coronarography. It has been observed that atenolol significantly decreases the weekly number of anginal attacks, and the amount of sublingual nitroglycerin consumption. It has been proved that atenolol successfully prevents the exercise-induced elevation of blood pressure and heart rate, increases exercise tolerance, decreases myocardial O2 consumption. The place among beta-blockers of the cardioselective, low lipophilic atenolol, which lacks membrane stabilizing and partial agonist activity, has been discussed. The administration of a single daily dose (one 100-mg tablet), selective cardiac effect, lack of unwanted side-effects (cold extremity, nightmare, insomnia, etc.) are the advantages of the drug.

Comparative evaluation of the effect of balloon dilatation by exercise precordial mapping and exercise 201-thallium scintigraphy.

Precordial exercise electrocardiographic mapping and exercise 201-thallium scintigraphy were simultaneously used on sixteen patients before, shortly after and three months after percutaneous transluminal coronary angioplasty (PTCA) to evaluate the immediate and late results of the intervention. In spite of the limited number of observations, positive exercise precordial mapping and or a reversible 201-thallium perfusion defect after PTCA seem to be indicative of failure of balloon dilatation or of development of restenosis in a given coronary artery. "Reverse minimum", that is the minimum in the resting precordial map which disappears on exercise, may be a sign of segmental coronary artery occlusion and well functioning collateral supply.

Antianginal effects of atenolol and pindolol in patients with stable effort angina pectoris.

A double blind, randomised crossover study with 20 patients was performed to compare the antianginal effects of atenolol 100 mg once daily and pindolol 5 mg thrice daily. After a placebo run-in period, 2 treatments were given for 2 wk each. The number of anginal attacks and the nitroglycerin (NTG) consumption were determined. During bicycle exercise testing, the systolic blood pressure (BP), heart rate (HR), double product and exercise tolerance were measured. Both drugs reduced the number of anginal attacks and NTG consumption relative to the placebo, with atenolol being more effective than pindolol. During exercise, both beta-blockers produced a slight increase in BP and HR compared to the placebo. HR attained with atenolol was lower than pindolol at the same workload. The total duration of exercise and the maximal tolerated workload were greater in atenolol than pindolol experiment. The special properties of beta-blockers, such as cardioselectivity or intrinsic sympathomimetic activity (ISA), may have clinical importance in the treatment of angina pectoris.

Atrial dissociation. A case of unilateral slow atrial rhythm.

Atrial dissociation is a very rare, transient arrhythmia frequently associated with intractable congestive heart failure. A case of atrial dissociation in a 48-year-old woman was observed in the first 72 hours of her recent inferolateral and probably atrial infarction. The slow unilateral rhythm was registered in the presence of sinus rhythm, 2:1 AV block, advanced AV block and ventricular pacemaker stimulation, respectively. The simultaneous right atrial electrogram indicated the origin of the isolated slow rhythm as left atrial. After temporary pacemaker therapy the atrial dissociation disappeared within three days; on the fifth day the normal sinus rhythm was restored spontaneously.

Captopril in heart failure.

The renin production, angiotensin II and aldosterone plasma levels have been proved to occur in heart failure. This pathological abnormalities can be stopped by the inhibition of ACE. This action of captopril is accompanied by a favourable clinical effects, the improvement of the symptoms of heart failure and the increase of sodium and water excretion and the increase of serum potassium level.