Lege Artis Medicinae

[Economic issues in health care - the Hungarian model]

NOVEMBER 30, 1994

Lege Artis Medicinae - 1994;4(11)

[The reform of the health care system is usually a marked requirement of regime change in new democracies. The population expects better care, more humane treatment, lower contributions, a more dignified health service, realistic wages and better professional conditions, alongside greater medical freedom. It soon became clear, however, that the (individually formulated) aspirations of the years around the change of regime, summarised in the heated, active discussions, the nights spent sailing, the forums - half the contributions, twice the services, with three times the pay - are not a reality. ]



Further articles in this publication

Lege Artis Medicinae

[The use of in situ hybridization in basic biomedical research and clinical medicine]


[The essential purpose of in situ hybridization is the histochemical and/or autoradiographic detection of specific nucleic acid sequences in cells, tissues or chromosomes. The method is based on the use of artificially manufactured DNA or RNA fragments which are label led with isotope, enzymes, biotin or digoxigenin. The specific attachment of these labelled single-stranded nucleic acid probes to intra nuclear or intracytoplasmic nucleic acids can be used for the study of gene expression, for the establishment of viral infections, for the diagnosis of specific tumours and for the detection of hereditary diseases and chromosomal aberrations. The present review discusses the molecular basis of the method, the possibilities of labelling and detection and various other applications.]

Lege Artis Medicinae

[The role of nutrition in the etiology and prevention of dental caries]


[Nutritional factors play an important role in the development of both dental caries and periodontal diseases. Dental caries is a multi factorial disease. The changes in the composition and accumulation of dental plaque, caused by physical and chemical components of the diet, are influenced by quantitative, qualitative and frequency factors of carbohydrate consumption. In the course of bacterial degradation of consumed sugars, acids are formed on the tooth by inherent dental plaque monosaccharides, and enamel demineralization occurs. Due to the multifactorial etiology of dental caries, prevention is a complex activity. In addition to fluoride prevention, appropriate oral hygiene measures, directives for a healthy diet, changes in life-style and behaviour are also important factors. For the elimination of the deleterious influence of carbohydrates, the decrease of between-meal snacks, and the use of non-acidogenic sugar substitutes (xylitol) is recommended, which might contribute to a decrease in the high caries prevalence rates in Hungary. ]

Lege Artis Medicinae

[Activated protein c response: a novel disorder causing thrombophilia]

PÁL András, SAS Géza, HAYNAL Imre, VAJDA Zoltán, KUNCZ Gabriella, MOHAMED A. Lateiwish, RÓNA Tas Ágnes

[In 1993 Dahlbäck described the so-called in vitro activated protein C response phenomena, according to which, the addition of activated protein C to citrated plasma samples prolongs the activated partial thromboplastin times. It was hypothesised that this phenomenon is the result of the action of a new protein C cofactor, and in 1994, Dahlbäck demonstrated that this phenomenon is linked to variations of the factor V, which surprisingly serves as a cofactor for protein C. In this study, forty-one highly selected thrombophilic patients and forty controls were investigated for the activated protein C response phenomenon. The response to activated protein C was expressed as the ratio of two activated partial thromboplastin times, the first in the presence of and the second in the absence of activated protein C. Eighteen patients demonstrated a decreased response, i. e. the ratio of the times was below 2.0 (mean 1.3). The average of the entire group was 1.86. The average ratio of the control group was 3.12, and there were 2 persons with ratios below 2.0. The results of this study correspond with the data in the literature. This newly recognised phenomenon may be responsible for the majority of the formerly unrecognised biochemical defects leading to the clinical picture of thrombophilia. ]

Lege Artis Medicinae

[Treatment for simplex glaucoma, eye drops or early surgery?]


[Primary open-angle glaucoma (simplex) occurs in -0.5-2% of the European population over 40 years of age and is one of the most common causes of blindness in countries with good public health. The visual field and visual impairment that has already developed with glaucoma is irreversible, so diagnosing the disease at an early stage and starting treatment at an early stage is a prerequisite for saving sight. Unfortunately, initiating treatment does not mean that retinal ganglion cell death and the resulting visual field loss will disappear. Although its rate slows down, progression can be detected in a significant proportion of eyes even with treatment. This is why the focus of glaucoma research today is to analyse the long-term efficacy of treatment.]

Lege Artis Medicinae


[MOTESZ is admitted to the European Union of Medical Specialists (UEMS); Hungarian-French medical education seminar; Smoking in the third trimester hinders foetal development; In Canada, cigarettes will only be sold in plain packaging in the future; Smoking during pregnancy can cause asthma in the unborn child; Smoking or health centre in NEVI; Smoking ban has not reduced restaurant sales in the US; Smoking during pregnancy can cause limb developmental abnormalities in the foetus; Dr. Zoltán Ajkay's five studies on health insurance reform; Diagnostic centre in Pécs; International meeting in Balatonszárszó; New information centre in Budapest;]

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Lege Artis Medicinae

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


Clinical Neuroscience

Comparison of direct costs of percutaneous full-endoscopic interlaminar lumbar discectomy and microdiscectomy: Results from Turkey

ÜNSAL Ünlü Ülkün, ŞENTÜRK Salim

Microdiscectomy (MD) is a stan­dard technique for the surgical treatment of lumbar disc herniation (LDH). Uniportal percutaneous full-endoscopic in­terlaminar lumbar discectomy (PELD) is another surgical op­tion that has become popular owing to reports of shorter hos­pitalization and earlier functional recovery. There are very few articles analyzing the total costs of these two techniques. The purpose of this study was to compare total hospital costs among microdiscectomy (MD) and uniportal percutaneous full-endoscopic interlaminar lumbar discectomy (PELD). Forty patients aged between 22-70 years who underwent PELD or MD with different anesthesia techniques were divided into four groups: (i) PELD-local anesthesia (PELD-Local) (n=10), (ii) PELD-general anesthesia (PELD-General) (n=10), (iii) MD-spinal anesthesia (MD-Spinal) (n=10), (iv) MD-general anesthesia (MD-General) (n=10). Health care costs were defined as the sum of direct costs. Data were then analyzed based on anesthetic modality to produce a direct cost evaluation. Direct costs were compared statistically between MD and PELD groups. The sum of total costs was $1,249.50 in the PELD-Local group, $1,741.50 in the PELD-General group, $2,015.60 in the MD-Spinal group, and $2,348.70 in the MD-General group. The sum of total costs was higher in the MD-Spinal and MD-General groups than in the PELD-Local and PELD-General groups. The costs of surgical operation, surgical equipment, anesthesia (anesthetist’s costs), hospital stay, anesthetic drugs and materials, laboratory wor­kup, nur­sing care, and postoperative me­dication diffe­red significantly among the two main groups (PELD-MD) (p<0.01). This study demonstrated that PELD is less costly than MD.

Clinical Neuroscience

[The connection between the socioeconomic status and stroke in Budapest]


[The well-known gap bet­ween stroke mortality of Eastern and Western Euro­pean countries may reflect the effect of socioeconomic diffe­rences. Such a gap may be present between neighborhoods of different wealth within one city. We set forth to compare age distribution, incidence, case fatality, mortality, and risk factor profile of stroke patients of the poorest (District 8) and wealthiest (District 12) districts of Budapest. We synthesize the results of our former comparative epidemiological investigations focusing on the association of socioeconomic background and features of stroke in two districts of the capital city of Hungary. The “Budapest District 8–12 project” pointed out the younger age of stroke patients of the poorer district, and established that the prevalence of smoking, alcohol-consumption, and untreated hypertension is also higher in District 8. The “Six Years in Two Districts” project involving 4779 patients with a 10-year follow-up revealed higher incidence, case fatality and mortality of stroke in the less wealthy district. The younger patients of the poorer region show higher risk-factor prevalence, die younger and their fatality grows faster during long-term follow-up. The higher prevalence of risk factors and the higher fatality of the younger age groups in the socioeconomically deprived district reflect the higher vulnerability of the population in District 8. The missing link between poverty and stroke outcome seems to be lifestyle risk-factors and lack of adherence to primary preventive efforts. Public health campaigns on stroke prevention should focus on the young generation of socioeconomi­cally deprived neighborhoods. ]

Clinical Neuroscience

[The Comprehensive Aphasia Test in Hungarian]


[In this paper we present the Comprehensive Aphasia Test-Hungarian (CAT-H; Zakariás and Lukács, in preparation), an assessment tool newly adapted to Hungarian, currently under standardisation. The test is suitable for the assessment of an acquired language disorder, post-stroke aphasia. The aims of this paper are to present 1) the main characteristics of the test, its areas of application, and the process of the Hungarian adaptation and standardisation, 2) the first results from a sample of Hungarian people with aphasia and healthy controls. Ninety-nine people with aphasia, mostly with unilateral, left hemisphere stroke, and 19 neurologically intact control participants were administered the CAT-H. In addition, we developed a questionnaire assessing demographic and clinical information. The CAT-H consists of two parts, a Cognitive Screening Test and a Language Test. People with aphasia performed significantly worse than the control group in all language and almost all cognitive subtests of the CAT-H. Consistent with our expectations, the control group performed close to ceiling in all subtests, whereas people with aphasia exhibited great individual variability both in the language and the cognitive subtests. In addition, we found that age, time post-onset, and type of stroke were associated with cognitive and linguistic abilities measured by the CAT-H. Our results and our experiences clearly show that the CAT-H provides a comprehensive profile of a person’s impaired and intact language abilities and can be used to monitor language recovery as well as to screen for basic cognitive deficits in aphasia. We hope that the CAT-H will be a unique resource for rehabilitation professionals and aphasia researchers in aphasia assessment and diagnostics in Hungary. ]

Clinical Neuroscience

[What happens to vertiginous population after emission from the Emergency Department?]

MAIHOUB Stefani, MOLNÁR András, CSIKÓS András, KANIZSAI Péter, TAMÁS László, SZIRMAI Ágnes

[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmel­weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]