Lege Artis Medicinae

[Application of the "homogeneous disease groups" patient classification system in hospital care analysis]


JUNE 30, 1993

Lege Artis Medicinae - 1993;3(06)

[In our previous communication, we described the principles and basic concepts of a patient classification system based on the formation of "homogeneous disease clusters (HBCs)", which allows a multifaceted analysis of hospital activity (1). In the same paper, we also reported our first methodological experience with the application of the HBCs classification system for the analysis of length of stay and hospital performance. In our next paper, we described the methodological possibilities offered by the HBCs patient classification system for retrospective and prospective analysis of the relationship between hospital performance and hospital budgets and for the design of performance-based internal financing (2). In this paper, we demonstrate how the HBCs patient classification system offers additional complex analytical possibilities for hospital management in terms of inpatient flow and inpatient performance by studying acute inpatient care in the clinics of a medical university and the wards of a county hospital. ]


  1. Debreceni Orvostudományi Egyetem Társadalomorvostani Intézete



Further articles in this publication

Lege Artis Medicinae

[The role of angiotenzin converting enzyme inhibitors in the treatment of hypertension]


[The role of the renin-angiotensin system in the regulation of blood pressure is outlined. The mechanism of action as well as the role of angiotensin converting enzyme inhibitors (ACEI) in the treatment of various forms (primary, secondary, uncomplicated, complicated) of hypertension is discussed. The individualized , stepped care" approach is detailed, therefore the advantages of the therapeutic combinations of ACEi-s are emphasized. Interactions with other antihypertensive agents and with other drugs are also described, and side effects are also briefly addressed]

Lege Artis Medicinae

[Postmenopausal hormone replacement therapy]

H S Jacobs, F E Loeffler

[Over the past year, a number of summary publications on postmenopausal hormone replacement therapy have been published in the UK (1-3). Therefore, in this review we focus on areas that, although often controversial, may be of interest to practitioners. We will discuss the effects of postmenopausal hormone therapy on the risk of ischaemic heart disease, osteoporosis and cancer and present some observations on the concept of oestrogen tachifilaxis and dependence. Our conclusions are summarised in our recommendations on hormone therapy in menopause.]

Lege Artis Medicinae

[Immunohistochemistry of atherosclerotic lesions]


[Cellular interactions within the arterial wall are considered to be essential in the development and progression of atherosclerotic lesions. This paper is a review of the actual knowledge about the role of the macrophages in the process of atherogenesis. The cellular composition of atherosclerotic changes – aligned in a possible consecutive order in which they may progress – are presented and discussed from the author's own immunohistochemical investigation. 108 aortic specimens obtained at autopsy performed within 12 hours following death from young people (20–34 ages) were examined. The Factor VIII positive endothelial lining was well preserved, no desmin content could be demonstrated. In contrary the presence of vimentin was noted in almost all the cells of the aortic wall. The foam cells reacted with different anti-macrophage antibodies, and most of the non-reacting cells of the different lesions proved to be smooth muscle cells. A considerable part of the intimal cells showed HLA-DR positivity as well. The quantity of the T helper lymphocytes in the lesions did not bear any significance. There was relationship between clinical data and types of (early) atherosclerotic lesions in the aorta. It is suggested, that the atherogenetic process starts in the intima with the appearance of smooth muscle cells and an increase in the lipid content. Thereafter macrophages accumulate and lead to the development of foam cells and at the same time they cause tissue damages leading to further smooth muscle proliferation and to classic atherosclerotic changes within the arterial wall.]

Lege Artis Medicinae

[Genetic counselling service at the congenital diaphragmatic defect]


[Recurrence risk of congenital diaphragmatic defect in a genetic counselling service has been investigated. Based on the investigation of 78 cases the risk of recurrence proved not significant. The families who have already had a newborn with congenital diaphragmatic defect may be suggested to bear subsequent pregnancies with the support of genetic counselling and intermittent ultrasonography. ]

Lege Artis Medicinae

[Studies of left ventricular dysfunction]


[510 patients (39.7%) in the placebo group and 452 patients (35.2%) in the enalapril group died. The reduction in cardiac mortality was mainly due to a reduction in progressive heart failure (placebo: 251, enalapril: 209; risk reduced by 22%). There was no appreciable reduction in mortality from arrhythmias without pump failure. However, fewer patients died or were hospitalised due to worsening of circulatory failure (placebo: 736, enalapril: 613; risk reduction 26%; p<0.001).]

All articles in the issue

Related contents

Clinical Neuroscience

Fluoxetine use is associated with improved survival of patients with COVID-19 pneumonia: A retrospective case-control study

NÉMETH Klára Zsófia, SZÛCS Anna , VITRAI József , JUHÁSZ Dóra , NÉMETH Pál János , HOLLÓ András

We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

Clinical Neuroscience

Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.

Clinical Neuroscience

[The role of sleep in the relational memory processes ]

CSÁBI Eszter, ZÁMBÓ Ágnes, PROKECZ Lídia

[A growing body of evidence suggests that sleep plays an essential role in the consolidation of different memory systems, but less is known about the beneficial effect of sleep on relational memory processes and the recognition of emotional facial expressions, however, it is a fundamental cognitive skill in human everyday life. Thus, the study aims to investigate the effect of timing of learning and the role of sleep in relational memory processes. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. Our results suggest that the timing of learning and sleep plays an important role in the stabilizing process of memory representation to resist against forgetting.]

Clinical Neuroscience

Alexithymia is associated with cognitive impairment in patients with Parkinson’s disease

SENGUL Yildizhan, KOCAK Müge, CORAKCI Zeynep, SENGUL Serdar Hakan, USTUN Ismet

Cognitive dysfunction (CD) is a common non-motor symptom of Parkinson’s disease (PD). Alexithy­mia is a still poorly understood neuropsychiatric feature of PD. Cognitive impairment (especially visuospatial dysfunction and executive dysfunction) and alexithymia share com­mon pathology of neuroanatomical structures. We hypo­thesized that there must be a correlation between CD and alexithymia levels considering this relationship of neuroanatomy. Objective – The aim of this study was to evaluate the association between alexithymia and neurocognitive function in patients with PD. Thirty-five patients with PD were included in this study. The Toronto Alexithymia Scale–20 (TAS-20), Geriatric Depression Inventory (GDI) and a detailed neuropsychological evaluation were performed. Higher TAS-20 scores were negatively correlated with Wechsler Adult Intelligence Scale (WAIS) similarities test score (r =-0.71, p value 0.02), clock drawing test (CDT) scores (r=-0.72, p=0.02) and verbal fluency (VF) (r=-0.77, p<0.01). Difficulty identifying feelings subscale score was negatively correlated with CDT scores (r=-0.74, p=0.02), VF scores (r=-0.66, p=0.04), visual memory immediate recall (r=-0.74, p=0.01). VF scores were also correlated with difficulty describing feelings (DDF) scores (r=-0.66, p=0.04). There was a reverse relationship bet­ween WAIS similarities and DDF scores (r=-0.70, p=0.02), and externally oriented-thinking (r=-0.77,p<0.01). Executive function Z score was correlated with the mean TAS-20 score (r=-62, p=0.03) and DDF subscale score (r=-0.70, p=0.01) Alexithymia was found to be associated with poorer performance on visuospatial and executive function test results. We also found that alexithymia was significantly correlated with depressive symptoms. Presence of alexithymia should therefore warn the clinicians for co-existing CD.

Lege Artis Medicinae

[LAM 30: 1990–2020. Facing the mirror: Three decades of LAM, the Hungarian medicine and health care system]